Provider Demographics
NPI:1104142728
Name:MOUNT SINAI COMMUNITY FOUNDATION
Entity type:Organization
Organization Name:MOUNT SINAI COMMUNITY FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF SINAI MEDICAL GROUP
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-257-5771
Mailing Address - Street 1:26460 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1264
Mailing Address - Country:US
Mailing Address - Phone:773-542-2000
Mailing Address - Fax:
Practice Address - Street 1:6224 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60636-2324
Practice Address - Country:US
Practice Address - Phone:773-778-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT SINAI COMMUNITY FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-08
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001982657854Medicaid