MEDICARE: ORAL SURGERY, MT. SINAI SCHOOL OF MEDICINE

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)

General Provider Information

NPI Number	:	1336249739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORAL SURGERY, MT. SINAI SCHOOL OF MEDICINE

Provider Business Mailing Address
First Line	:	1 GUSTAVE L. LEVY PLACE, BOX 1187
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	11209
Country	:	US
Telephone Number	:	212-241-0300
Fax Number	:	212-996-9793

Provider Business Practice Location Address
First Line	:	1 GUSTAVE L. LEVY PLACE, BOX 1187
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	11209
Country	:	US
Telephone Number	:	212-241-0300
Fax Number	:	212-996-9793

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	KATHALEEN GRANT
Credential	:	MHSA
Telephone Number	:	212-241-0806

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	08/22/2020

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