1801239991 NPI number — MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801239991 NPI number — MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SMG AT SCI-MEDICINE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801239991
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3537 PAYSPHERE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60674-0035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-786-2900
Provider Business Mailing Address Fax Number:
708-786-2992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2653 W OGDEN AVE
Provider Second Line Business Practice Location Address:
3RD FLOOR SUITE A,
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60608-1647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-257-6840
Provider Business Practice Location Address Fax Number:
773-257-6712
Provider Enumeration Date:
04/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
VAZQUEZ
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
CMO
Authorized Official Telephone Number:
773-257-6850

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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