1013489426 NPI number — ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI

Table of content: (NPI 1013489426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013489426 NPI number — ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
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:
Provider Other Organization Name Type Code:
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:
1013489426
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 E 42ND ST FL 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10017-5626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-605-8119
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 MADISON AVE # LEVEL1B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10010-3643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-899-5975
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/24/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CORDEN
Authorized Official First Name:
KERRY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
DELEGATED OFFICIAL
Authorized Official Telephone Number:
646-605-8119

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084B0040X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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