Provider Demographics
NPI:1942430244
Name:MOUNT SINAI SCHOOL OF MEDICINE
Entity Type:Organization
Organization Name:MOUNT SINAI SCHOOL OF MEDICINE
Other - Org Name:MOUNT SINAI ELMHURST FACULTY PRACTICE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-334-2061
Mailing Address - Street 1:7901 BROADWAY
Mailing Address - Street 2:ROOM A1-19
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1329
Mailing Address - Country:US
Mailing Address - Phone:718-334-4952
Mailing Address - Fax:718-334-4815
Practice Address - Street 1:7901 BROADWAY
Practice Address - Street 2:ROOM A1-19
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-4952
Practice Address - Fax:718-334-4815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53241Medicare PIN