Provider Demographics
NPI:1881037976
Name:MOUNT SINAI COMMUNITY FOUNDATION DBA SINIA MEDICAL GROUP
Entity Type:Organization
Organization Name:MOUNT SINAI COMMUNITY FOUNDATION DBA SINIA MEDICAL GROUP
Other - Org Name:SMG AT SCI PEDIATRICS
Other - Org Type:Other Name
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 1:3537 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0035
Mailing Address - Country:US
Mailing Address - Phone:708-786-2900
Mailing Address - Fax:708-786-2992
Practice Address - Street 1:2653 W OGDEN AVE
Practice Address - Street 2:3RD FLOOR SUITE A,
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1647
Practice Address - Country:US
Practice Address - Phone:773-257-6892
Practice Address - Fax:773-257-6894
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT SINAI COMMUNITY FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty