1508533472 NPI number — MOUNT SINAI VASCULAR INSTITUTE, LLC

Table of content: TONYA ANN DOLLY LICSW (NPI 1164658860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508533472 NPI number — MOUNT SINAI VASCULAR INSTITUTE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNT SINAI VASCULAR INSTITUTE, LLC
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:
1508533472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 527227
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33152-7227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-674-2906
Provider Business Mailing Address Fax Number:
305-674-3927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3401 NORTHSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEY WEST
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33040-4238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-674-2906
Provider Business Practice Location Address Fax Number:
305-674-3927
Provider Enumeration Date:
08/27/2021

Additional Information

Authorized Official

Authorized Official Last Name:
CHUTKAN
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VP FINANCE
Authorized Official Telephone Number:
305-674-2121

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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