Basic Information
| Provider Information | |||||||||
| NPI: | 1558698498 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT SINAI SCHOOL OF MEDICINE DEPARTMENT OF ORTHOPAEDIC SURGERY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 E 98TH ST | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100296501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122416980 | ||||||||
| FaxNumber: | 2125346091 | ||||||||
| Practice Location | |||||||||
| Address1: | 433 HACKENSACK AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076016319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013431717 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2009 | ||||||||
| LastUpdateDate: | 11/13/2009 | ||||||||
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| AuthorizedOfficialLastName: | JABS | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2122416980 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. M.B.A | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.