Provider Demographics
NPI:1487672044
Name:SUNG, MAX W
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:W
Last Name:SUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MOUNT SINAI DEPARTMENT OF MEDICINE
Mailing Address - Street 2:1 GUSTAVE L LEVY PLACE BOX 3000
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-987-3100
Mailing Address - Fax:212-731-5210
Practice Address - Street 1:MOUNT SINAI HOSPITAL-RUTTENBERG TREATMENT CENTER
Practice Address - Street 2:1190 5TH AVENUE GUGGENHEIM PAVILL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-6756
Practice Address - Fax:212-423-0522
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153309207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E10525Medicare UPIN
15F621Medicare ID - Type Unspecified