Basic Information
| Provider Information | |||||||||
| NPI: | 1821049172 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MOUNT SINAI HOSPITAL OF GREATER MIAMI, INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 ALTON RD | ||||||||
| Address2: | 5 WARNER | ||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331402800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056742662 | ||||||||
| FaxNumber: | 3056742007 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 ALTON RD | ||||||||
| Address2: | 5 WARNER | ||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331402800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056742662 | ||||||||
| FaxNumber: | 3056742007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 11/04/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CHUTKAN | ||||||||
| AuthorizedOfficialFirstName: | WAYNE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3056742662 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | CPA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | 4066 | FL | Y | Hospital Units | Rehabilitation Unit |
No ID Information.