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General NPI Number Information
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NPI Number | 1790112480
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Entity Type | Organization
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Legal Business Name | MOUNT SINAI COMMUNITY FOUNDATION
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 12/27/2013
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Provider Practice Location Address
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Address Line | 2701 W 68TH ST
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City | CHICAGO
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State | IL
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Zip | 60629-1813
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Country | US
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Telephone | 773-257-6672
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Fax | 773-257-5330
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Provider Business Mailing Address
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Address Line | 26460 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1264
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Country | US
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Telephone | 708-786-2905
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Fax | 773-782-8500
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Authorized Official
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Title or Position | CMO
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Name | JOHN E VAZQUEZ
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Credential | MD
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Telephone | 773-257-6850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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