Provider Demographics
NPI:1447274865
Name:MOUNT SINAI SCHOOL OF MEDICINE
Entity type:Organization
Organization Name:MOUNT SINAI SCHOOL OF MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO FPA ASSOCIATES
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:JABS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:212-241-6752
Mailing Address - Street 1:PO BOX 12097
Mailing Address - Street 2:515 UNION BOULEVARD
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-5097
Mailing Address - Country:US
Mailing Address - Phone:212-241-0025
Mailing Address - Fax:212-987-2468
Practice Address - Street 1:1184 5TH AVE
Practice Address - Street 2:BOX 1236
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6503
Practice Address - Country:US
Practice Address - Phone:212-241-0025
Practice Address - Fax:212-987-2468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWZZZY1Medicare PIN