Provider Demographics
NPI:1811224868
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: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 1:521 ROUTE 111
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4370
Mailing Address - Country:US
Mailing Address - Phone:631-361-4625
Mailing Address - Fax:631-361-2021
Practice Address - Street 1:521 ROUTE 111
Practice Address - Street 2:SUITE 202
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4370
Practice Address - Country:US
Practice Address - Phone:631-361-4625
Practice Address - Fax:631-361-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159827207R00000X
NY157830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty