Basic Information
| Provider Information | |||||||||
| NPI: | 1750649612 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI | ||||||||
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| OtherOrganizationName: | TISCH DEPARTMENT OF MOUNT SINAI | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 28082 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100878082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129873100 | ||||||||
| FaxNumber: | 2127315210 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 GUSTAVE L LEVY PL | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100296574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122416756 | ||||||||
| FaxNumber: | 2124230522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2012 | ||||||||
| LastUpdateDate: | 06/24/2015 | ||||||||
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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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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.