Provider Demographics
NPI:1346250008
Name:MOUNT SINAI SCHOOL OF MEDICINE
Entity Type:Organization
Organization Name:MOUNT SINAI SCHOOL OF MEDICINE
Other - Org Name:MOUNT SINAI SCHOOL OF MEDICINE OBGYN FACULTY PRACTICE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERDEBES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-241-5423
Mailing Address - Street 1:5 E 98TH ST
Mailing Address - Street 2:BOX 1174
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6501
Mailing Address - Country:US
Mailing Address - Phone:212-241-8470
Mailing Address - Fax:212-241-3023
Practice Address - Street 1:5 E 98TH ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-8470
Practice Address - Fax:212-241-3023
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MT. SINAI SCHOOL OF MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-08
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW08172Medicare Oscar/Certification