Provider Demographics
NPI:1336249739
Name:ORAL SURGERY, MT. SINAI SCHOOL OF MEDICINE
Entity Type:Organization
Organization Name:ORAL SURGERY, MT. SINAI SCHOOL OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHALEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:212-241-0806
Mailing Address - Street 1:1 GUSTAVE L. LEVY PLACE, BOX 1187
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:212-241-0300
Mailing Address - Fax:212-996-9793
Practice Address - Street 1:1 GUSTAVE L. LEVY PLACE, BOX 1187
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11209
Practice Address - Country:US
Practice Address - Phone:212-241-0300
Practice Address - Fax:212-996-9793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty