Provider Demographics
NPI:1659545986
Name:MOUNT SINAI MEDICAL CENTER
Entity Type:Organization
Organization Name:MOUNT SINAI MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOUSE STAFF RESIDENT PL-3
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:PENETRANTE
Authorized Official - Last Name:MANAIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-257-1885
Mailing Address - Street 1:CALIFORNIA AVE AT 15TH ST.
Mailing Address - Street 2:F44
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608
Mailing Address - Country:US
Mailing Address - Phone:773-257-6183
Mailing Address - Fax:
Practice Address - Street 1:5030 N RIDGEWAY AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-6022
Practice Address - Country:US
Practice Address - Phone:773-257-6183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren