Provider Demographics
NPI:1760721955
Name:SINAI MEDICAL GROUP DIABETES EDUCATION PROGRAM 003816
Entity Type:Organization
Organization Name:SINAI MEDICAL GROUP DIABETES EDUCATION PROGRAM 003816
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT SINAI MEDIAL GROUP
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-257-5771
Mailing Address - Street 1:26460 NETWORK PLACE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0001
Mailing Address - Country:US
Mailing Address - Phone:773-257-2820
Mailing Address - Fax:773-762-8529
Practice Address - Street 1:2653 W OGDEN AVE STE 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1647
Practice Address - Country:US
Practice Address - Phone:773-257-6701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MT SINAI COMMUNITY FOUNDATION D/B/A SINAI MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-07
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center