Provider First Line Business Practice Location Address:
ONE GUSTAVE L. PLACE
Provider Second Line Business Practice Location Address:
MOUNT SINAI HOSPITAL/ICAHN SCHOOL OF MEDICINE AT MOUNT
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-241-3419
Provider Business Practice Location Address Fax Number:
212-534-2845
Provider Enumeration Date:
02/20/2026