Provider Demographics
NPI:1417226606
Name:MOUNT SINAI HOSPITAL
Entity Type:Organization
Organization Name:MOUNT SINAI HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR, FAMILY MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:IHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-257-6097
Mailing Address - Street 1:528 FOREST MEWS DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2618
Mailing Address - Country:US
Mailing Address - Phone:630-484-5911
Mailing Address - Fax:
Practice Address - Street 1:528 FOREST MEWS DR
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2618
Practice Address - Country:US
Practice Address - Phone:630-484-5911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-129334282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital