Provider Demographics
NPI:1629410592
Name:MOUNT SINAI
Entity Type:Organization
Organization Name:MOUNT SINAI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSOCIATE
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:212-824-8100
Mailing Address - Street 1:59 E MAIN ST
Mailing Address - Street 2:SUITE 13
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8332
Mailing Address - Country:US
Mailing Address - Phone:212-824-8100
Mailing Address - Fax:212-996-2230
Practice Address - Street 1:1468 MADISON AVE
Practice Address - Street 2:BOX 1116
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6508
Practice Address - Country:US
Practice Address - Phone:631-824-8100
Practice Address - Fax:212-996-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-21
Last Update Date:2013-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16550282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access