Provider Demographics
NPI:1356697627
Name:NORTH SHORE MEDICAL GROUP OF MOUNT SINAI SCHOOL OF MEDICINE
Entity type:Organization
Organization Name:NORTH SHORE MEDICAL GROUP OF MOUNT SINAI SCHOOL OF MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:STREET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-351-3703
Mailing Address - Street 1:19 E MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8330
Mailing Address - Country:US
Mailing Address - Phone:631-665-6393
Mailing Address - Fax:631-665-5870
Practice Address - Street 1:19 E MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8330
Practice Address - Country:US
Practice Address - Phone:631-665-6393
Practice Address - Fax:631-665-5870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty