MEDICARE: MOUNT SINAI MEDICAL CENTER

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	282NC0060X	Critical Access Hospital

General Provider Information

NPI Number	:	1922319771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT SINAI MEDICAL CENTER

Provider Business Mailing Address
First Line	:	526B SEAVIEW AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3402
Country	:	US
Telephone Number	:	718-351-7833
Fax Number	:	718-351-7833

Provider Business Practice Location Address
First Line	:	526B SEAVIEW AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3402
Country	:	US
Telephone Number	:	718-351-7833
Fax Number	:	718-351-7833

Authorized Official
Title or Position	:	CRITICAL CARE MEDICINE FELLOW
Name	:	DR. BLANCHE MEREDITH TELESFORD
Credential	:	M.D.
Telephone Number	:	954-319-7704

Provider Enumeration Date	:	06/27/2010
Last Update Date	:	06/27/2010

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