Basic Information
| Provider Information | |||||||||
| NPI: | 1205207875 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT SINAI HOSPITAL MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 FOX RUN | ||||||||
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| City: | STURBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015661232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083447504 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5 E 98TH ST | ||||||||
| Address2: | FLOOR 2 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100296501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122417952 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2015 | ||||||||
| LastUpdateDate: | 10/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | LACOSTE | ||||||||
| AuthorizedOfficialFirstName: | NICOLE | ||||||||
| AuthorizedOfficialMiddleName: | JOAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 5083447504 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PA-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 019025-1 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.