Provider Demographics
NPI:1306151865
Name:ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Entity type:Organization
Organization Name:ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, CBO DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MACNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-605-8112
Mailing Address - Street 1:150 E 42ND. STREET
Mailing Address - Street 2:10TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5626
Mailing Address - Country:US
Mailing Address - Phone:212-987-3100
Mailing Address - Fax:646-605-3029
Practice Address - Street 1:108 DELANCEY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-3202
Practice Address - Country:US
Practice Address - Phone:212-659-8552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT SINAI HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-09
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty