Provider Demographics
NPI:1336413442
Name:MOUNT SINAI SCHOOL OF MEDICINE FACULTY PRACTICE ASSOCIATES
Entity Type:Organization
Organization Name:MOUNT SINAI SCHOOL OF MEDICINE FACULTY PRACTICE ASSOCIATES
Other - Org Name:OTOLARYNGOLOGY DEPARTMENT OF MOUNT SINAI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CBO VICE PRESIDENT
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:P.O. 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:212-241-5957
Mailing Address - Fax:212-831-3700
Practice Address - Street 1:5 E 98TH ST FL 8
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:212-241-5957
Practice Address - Fax:212-831-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty