1245575927 NPI number — FACULTY PRACTICE ASSOCIATGE, MOUNT SINAI SCHOOL OF MEDICINE

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 1245575927 NPI number — FACULTY PRACTICE ASSOCIATGE, MOUNT SINAI SCHOOL OF MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FACULTY PRACTICE ASSOCIATGE, MOUNT SINAI SCHOOL OF MEDICINE
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:
6
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:
1245575927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1190 5TH AVE
Provider Second Line Business Mailing Address:
BOX 1028
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10029-6503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-241-5646
Provider Business Mailing Address Fax Number:
212-241-0038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1190 5TH AVE
Provider Second Line Business Practice Location Address:
BOX 1028
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029-6503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-241-5646
Provider Business Practice Location Address Fax Number:
212-241-0038
Provider Enumeration Date:
12/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WARKENTHIEN
Authorized Official First Name:
BETH
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
212-241-4546

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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