1023351079 NPI number — DR. CAROLINE O BLACK M.D.

Table of content: DR. CAROLINE O BLACK M.D. (NPI 1023351079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023351079 NPI number — DR. CAROLINE O BLACK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLACK
Provider First Name:
CAROLINE
Provider Middle Name:
O
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADEGITE
Provider Other First Name:
CAROLINE
Provider Other Middle Name:
O
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023351079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1149 ONE GUSTATVE PLACE
Provider Second Line Business Mailing Address:
MT SINAI MEDICAL CENTER DEPT OF EMERGENCY MEDICINE
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10029-0311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-824-8069
Provider Business Mailing Address Fax Number:
212-241-1279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EMERGENCY DEPARTMENT
Provider Second Line Business Practice Location Address:
5 PERRYRIDGE ROAD
Provider Business Practice Location Address City Name:
GREENWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
32-863-3637
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207PP0204X , with the licence number:  25MA10612900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207PP0204X , with the licence number: 79850 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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