Basic Information
| Provider Information | |||||||||
| NPI: | 1316982424 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT SINAI HOSPITAL QUEENS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2510 30TH AVE | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111022448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182674285 | ||||||||
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| Address1: | 2510 30TH AVE | ||||||||
| Address2: | |||||||||
| City: | LONG ISLAND CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111022448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182674285 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 11/19/2007 | ||||||||
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| AuthorizedOfficialLastName: | HENDRIX | ||||||||
| AuthorizedOfficialFirstName: | NICOLE | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | RPAC | ||||||||
| AuthorizedOfficialTelephone: | 3478800186 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 007595 | NY | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 2272966 | 05 | NY | MEDICAID |