Provider Demographics
NPI:1891053336
Name:FACULTY PRACTICE ASSOCIATES MOUNT SINAI SCHOOL OF MEDICINE
Entity Type:Organization
Organization Name:FACULTY PRACTICE ASSOCIATES MOUNT SINAI SCHOOL OF MEDICINE
Other - Org Name:REHABILITATION MEDICINE DEPARTMENT OF MOUNT SINAI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, CBO DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MACNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-731-6802
Mailing Address - Street 1:PO BOX 28082
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-8082
Mailing Address - Country:US
Mailing Address - Phone:212-241-9469
Mailing Address - Fax:212-369-6389
Practice Address - Street 1:5 E 98TH ST BOX 1240B- 6TH FLOOR
Practice Address - Street 2:
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:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty