Provider Demographics
NPI:1083861926
Name:MOUNTSINAI HOSPITAL
Entity Type:Organization
Organization Name:MOUNTSINAI HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PGY-2
Authorized Official - Prefix:MRS
Authorized Official - First Name:RADHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DASARAJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-660-1837
Mailing Address - Street 1:1500 S CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1729
Mailing Address - Country:US
Mailing Address - Phone:773-257-6183
Mailing Address - Fax:
Practice Address - Street 1:1500 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1729
Practice Address - Country:US
Practice Address - Phone:773-257-6183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty