1922411065 NPI number — ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI

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 1922411065 NPI number — ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI

Organization/Personal Information

Employer Identification Number (EIN):
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:
OB/GYN DEPARTMENT OF MOUNT SINAI SLR
Provider Other Organization Name Type Code:
3
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:
1922411065
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 EAST 42ND STREET
Provider Second Line Business Mailing Address:
10TH FL.
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:
646-605-3029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 10TH AVE
Provider Second Line Business Practice Location Address:
SUITE 10C
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10019-1147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-523-3452
Provider Business Practice Location Address Fax Number:
212-523-8066
Provider Enumeration Date:
06/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MACNEILL
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, CBO DIRECTOR
Authorized Official Telephone Number:
646-605-8112

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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