Provider Demographics
NPI:1134148257
Name:SKLOOT, GWEN S (MD)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:S
Last Name:SKLOOT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 GUSTAVE L LEVY PLACE BOX 3000
Mailing Address - Street 2:MOUNT SINAI DEPARTMENT OF MEDICINE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-987-3100
Mailing Address - Fax:212-731-5210
Practice Address - Street 1:5 EAST 98TH STREET
Practice Address - Street 2:10TH FLOOR BO MOUNT SINAI HOSPITAL PULMONARY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-5656
Practice Address - Fax:212-241-8866
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY182688207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
47K711Medicare ID - Type Unspecified
F58119Medicare UPIN