Provider Demographics
NPI: | 1588860092 |
---|---|
Name: | MOUNT SINAI COMMUNITY FOUNDATION |
Entity Type: | Organization |
Organization Name: | MOUNT SINAI COMMUNITY FOUNDATION |
Other - Org Name: | SINAI MEDICAL GROUP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CHIEF MECIACL OFFICER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | C |
Authorized Official - Last Name: | PARKER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 773-257-6542 |
Mailing Address - Street 1: | 3537 PAYSPHERE CIR |
Mailing Address - Street 2: | |
Mailing Address - City: | CHICAGO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60674-0035 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 708-786-2900 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1501 S CALIFORNIA AVE |
Practice Address - Street 2: | NR513 |
Practice Address - City: | CHICAGO |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60608-1732 |
Practice Address - Country: | US |
Practice Address - Phone: | 773-257-6221 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-06-22 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 283Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 283Q00000X | Hospitals | Psychiatric Hospital |