Provider Demographics
NPI:1629494224
Name:MOUNT SINAI COMMUNITY FOUNDATION
Entity Type:Organization
Organization Name:MOUNT SINAI COMMUNITY FOUNDATION
Other - Org Name:SOUTHWEST HEMATOLOGY/ONCOLOGY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-257-6850
Mailing Address - Street 1:6319 W 87TH ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-233-5636
Mailing Address - Fax:
Practice Address - Street 1:26460 NETWORK PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60673-1264
Practice Address - Country:US
Practice Address - Phone:708-786-2900
Practice Address - Fax:708-786-2992
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT SINAI COMMUNITY FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty