Basic Information
| Provider Information | |||||||||
| NPI: | 1427493113 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI | ||||||||
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| OtherOrganizationName: | ENVIRONMENTAL MEDICINE AT MOUNT SINAI | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 EAST 42ND STREET | ||||||||
| Address2: | 10TH FL. | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100175626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466058119 | ||||||||
| FaxNumber: | 6466053029 | ||||||||
| Practice Location | |||||||||
| Address1: | 1468 MADISON AVE FL 3 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100296508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887020630 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2013 | ||||||||
| LastUpdateDate: | 02/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | MACNEILL | ||||||||
| AuthorizedOfficialFirstName: | CRYSTAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT, CBO DIRECTOR, | ||||||||
| AuthorizedOfficialTelephone: | 6466058112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
No ID Information.