1255882734 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 1255882734 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:
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:
1255882734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
129 SLOSSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10314-2522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-720-5928
Provider Business Mailing Address Fax Number:
718-720-6706

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 SLOSSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10314-2522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-720-5928
Provider Business Practice Location Address Fax Number:
718-720-6706
Provider Enumeration Date:
10/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GRESHAM
Authorized Official First Name:
ALICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF NETWORK OPERATIONS
Authorized Official Telephone Number:
212-659-9038

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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