Provider Demographics
NPI:1427493113
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:VICE PRESIDENT, CBO DIRECTOR,
Authorized Official - Prefix:MRS
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 EAST 42ND STREET
Mailing Address - Street 2:10TH FL.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5626
Mailing Address - Country:US
Mailing Address - Phone:646-605-8119
Mailing Address - Fax:646-605-3029
Practice Address - Street 1:1468 MADISON AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6508
Practice Address - Country:US
Practice Address - Phone:888-702-0630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine