Basic Information
| Provider Information | |||||||||
| NPI: | 1104471622 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 S CALIFORNIA AVE NR 7-130 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732572905 | ||||||||
| FaxNumber: | 7732571788 | ||||||||
| Practice Location | |||||||||
| Address1: | 645 S CENTRAL AVE FL 6 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606445059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738545328 | ||||||||
| FaxNumber: | 7738545587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2019 | ||||||||
| LastUpdateDate: | 08/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | CAPUTO | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7732572905 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
No ID Information.