Provider Demographics
NPI:1659393478
Name:MOUNT SINAI SCHOOL OF MEDICINE
Entity Type:Organization
Organization Name:MOUNT SINAI SCHOOL OF MEDICINE
Other - Org Name:INTERVENTIONAL MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FREDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURSTYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-659-9367
Mailing Address - Street 1:5 E 98TH ST
Mailing Address - Street 2:BOX1240B-6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6501
Mailing Address - Country:US
Mailing Address - Phone:212-241-9469
Mailing Address - Fax:212-369-6389
Practice Address - Street 1:5 E 98TH ST
Practice Address - Street 2:BOX1240B-6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-9469
Practice Address - Fax:212-369-6389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWZZVP1OtherMEDICARE PIN
NYWZZVP1OtherMEDICARE PIN