Basic Information
| Provider Information | |||||||||
| NPI: | 1912964768 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC | ||||||||
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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: | 04/26/2006 | ||||||||
| LastUpdateDate: | 11/04/2011 | ||||||||
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| AuthorizedOfficialLastName: | CHUTKAN | ||||||||
| AuthorizedOfficialFirstName: | WAYNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3056742662 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 800017502 | FL | N | Laboratories | Clinical Medical Laboratory | 282N00000X | 4066 | FL | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | Z25 | 01 | FL | BLUE CROSS OF FL REHAB | OTHER | 010046300 | 05 | FL | MEDICAID | 226 | 01 | FL | BLUE CROSS OF FLORIDA | OTHER |