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General NPI Number Information
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NPI Number | 1962646091
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Entity Type | Organization
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Legal Business Name | NORTH SHORE MEDICAL GROUP OF THE MOUNT SINAI SCHOOL OF MEDICINE
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 59 SOUTHERN BLVD
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City | NESCONSET
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State | NY
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Zip | 11767-1090
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Country | US
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Telephone | 631-659-1700
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Fax | 631-659-1750
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Provider Business Mailing Address
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Address Line | 59 SOUTHERN BLVD
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City | NESCONSET
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State | NY
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Zip | 11767-1090
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Country | US
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Telephone | 631-659-1700
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Fax | 631-659-1750
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MS. JANET STREET
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Credential |
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Telephone | 631-351-3703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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