Provider Demographics
NPI:1285178855
Name:MOUNT SINAI ADOLESCENT HEALTH CENTER
Entity Type:Organization
Organization Name:MOUNT SINAI ADOLESCENT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:POLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYZMAN-TABAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-731-5236
Mailing Address - Street 1:320 E 94TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5604
Mailing Address - Country:US
Mailing Address - Phone:212-423-2861
Mailing Address - Fax:
Practice Address - Street 1:320 E 94TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5604
Practice Address - Country:US
Practice Address - Phone:212-423-2861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT SINAI HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Single Specialty