Provider Demographics
NPI:1912964768
Name:MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC
Entity type:Organization
Organization Name:MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUTKAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:305-674-2662
Mailing Address - Street 1:4300 ALTON RD
Mailing Address - Street 2:5 WARNER
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2800
Mailing Address - Country:US
Mailing Address - Phone:305-674-2662
Mailing Address - Fax:305-674-2007
Practice Address - Street 1:4300 ALTON RD
Practice Address - Street 2:5 WARNER
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2800
Practice Address - Country:US
Practice Address - Phone:305-674-2662
Practice Address - Fax:305-674-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800017502291U00000X
FL4066282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ25OtherBLUE CROSS OF FL REHAB
FL010046300Medicaid
FL226OtherBLUE CROSS OF FLORIDA
FLZ25OtherBLUE CROSS OF FL REHAB