Provider Demographics
NPI:1578098562
Name:ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI CVI CENTER FOR HEALTH AT MT SI
Entity Type:Organization
Organization Name:ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI CVI CENTER FOR HEALTH AT MT SI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXA
Authorized Official - Middle Name:
Authorized Official - Last Name:BESGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-437-5850
Mailing Address - Street 1:PO BOX 21291
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-1291
Mailing Address - Country:US
Mailing Address - Phone:212-731-3421
Mailing Address - Fax:212-731-3449
Practice Address - Street 1:234 E 85TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-3135
Practice Address - Country:US
Practice Address - Phone:212-731-3421
Practice Address - Fax:212-731-3449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty