Provider Demographics
NPI:1629202445
Name:SINAI HOSPITAL OF BALTIMORE, INC
Entity Type:Organization
Organization Name:SINAI HOSPITAL OF BALTIMORE, INC
Other - Org Name:SINAI CLINICAL PROFESSIONALS PT D/B/A CLINICAL ASSOCIATES PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-296-5300
Mailing Address - Street 1:515 FAIRMOUNT AVE
Mailing Address - Street 2:STE. 530
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5466
Mailing Address - Country:US
Mailing Address - Phone:410-494-1389
Mailing Address - Fax:410-494-1386
Practice Address - Street 1:515 FAIRMOUNT AVE
Practice Address - Street 2:CREDENTIALING OFFICE
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5466
Practice Address - Country:US
Practice Address - Phone:410-494-1324
Practice Address - Fax:410-494-1361
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SINAI HOSPTIAL OF BALTIMORE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-07
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD479908901Medicaid
MD109MMedicare PIN
MD163440Medicare PIN