Provider Demographics
NPI:1407264583
Name:MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP
Entity Type:Organization
Organization Name:MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP
Other - Org Name:SINAI CONVENIENT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-257-2905
Mailing Address - Street 1:26460 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-3012
Mailing Address - Country:US
Mailing Address - Phone:773-257-2500
Mailing Address - Fax:
Practice Address - Street 1:1859 S BLUE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3012
Practice Address - Country:US
Practice Address - Phone:773-738-3111
Practice Address - Fax:773-738-5211
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-01
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty