MEDICARE: MOUNT SINAI SCHOOL OF MEDICINE OF NEW YORK UNIVERSITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1104135060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT SINAI SCHOOL OF MEDICINE OF NEW YORK UNIVERSITY

Provider Business Mailing Address
First Line	:	100 E 77TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10075-1850
Country	:	US
Telephone Number	:	212-427-6101
Fax Number	:	212-427-6128

Provider Business Practice Location Address
First Line	:	1 GUSTAVE L LEVY PL
Second Line	:	BOX # 1621
City	:	NEW YORK
State	:	NY
Zip	:	10029-6500
Country	:	US
Telephone Number	:	212-731-7895
Fax Number	:	212-348-6158

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER, FPA
Name	:	DOUGLAS A. JABS
Credential	:	M.D., M.B.A.
Telephone Number	:	212-241-6752

Provider Enumeration Date	:	09/27/2010
Last Update Date	:	09/27/2010

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Directions to “MOUNT SINAI SCHOOL OF MEDICINE OF NEW YORK UNIVERSITY ” Practice Location

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