1104135060 NPI number — MOUNT SINAI SCHOOL OF MEDICINE OF NEW YORK UNIVERSITY

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 1104135060 NPI number — MOUNT SINAI SCHOOL OF MEDICINE OF NEW YORK UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNT SINAI SCHOOL OF MEDICINE OF NEW YORK UNIVERSITY
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:
1104135060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E 77TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10075-1850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-427-6101
Provider Business Mailing Address Fax Number:
212-427-6128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 GUSTAVE L LEVY PL
Provider Second Line Business Practice Location Address:
BOX # 1621
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029-6500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-731-7895
Provider Business Practice Location Address Fax Number:
212-348-6158
Provider Enumeration Date:
09/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JABS
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER, FPA
Authorized Official Telephone Number:
212-241-6752

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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