Provider Demographics
NPI:1407113335
Name:MOUNT SINAI SCHOOL OF MEDICINE OF NEW YORK UNIVERSITY
Entity Type:Organization
Organization Name:MOUNT SINAI SCHOOL OF MEDICINE OF NEW YORK UNIVERSITY
Other - Org Name:MT SINAI QUEENS CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CBO DIRECTOR, VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRYATAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MACNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-731-6802
Mailing Address - Street 1:PO BOX 28082
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-8082
Mailing Address - Country:US
Mailing Address - Phone:212-731-7906
Mailing Address - Fax:212-731-6753
Practice Address - Street 1:1125 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1243
Practice Address - Country:US
Practice Address - Phone:212-369-4250
Practice Address - Fax:212-369-4427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty