MEDICARE: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RH0000X	Hematology (Internal Medicine) Physician
2	207RX0202X	Medical Oncology Physician
3	207RH0003X	Hematology & Oncology Physician

General Provider Information

NPI Number	:	1740773936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI

Provider Business Mailing Address
First Line	:	1910 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2552
Country	:	US
Telephone Number	:	718-987-1430
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2552
Country	:	US
Telephone Number	:	718-987-9777
Fax Number	:

Authorized Official
Title or Position	:	VP NETWORK OPERATIONS
Name	:	ALICIA GRESHAM
Credential	:
Telephone Number	:	212-659-9038

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	01/17/2020

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Directions to “ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI ” Practice Location

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