Provider Demographics
NPI:1316982424
Name:MOUNT SINAI HOSPITAL QUEENS
Entity type:Organization
Organization Name:MOUNT SINAI HOSPITAL QUEENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPAC
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:P
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-880-0186
Mailing Address - Street 1:2510 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2448
Mailing Address - Country:US
Mailing Address - Phone:718-267-4285
Mailing Address - Fax:
Practice Address - Street 1:2510 30TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11102-2448
Practice Address - Country:US
Practice Address - Phone:718-267-4285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007595282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2272966Medicaid
NY0421AEMedicare ID - Type Unspecified
NY2272966Medicaid