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Organization
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Active
Organization
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Active
Other names
MOUNT SINAI DOCTORS SOUTH NASSAU - OB/GYN, MOUNT SINAI DOCTORS SOUTH NASSAU-OB/GYN
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA GRESHAM (VP OF NETWORK OPERATIONS)
(212) 659-9038
Entity
Organization
Contact information
Practice address
196 MERRICK RD, OCEANSIDE, NY 11572
(516) 255-8400
Mailing address
1 HEALTHY WAY, OCEANSIDE, NY 11572-1551
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
Primary
—
NULL
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
207VX0000X
Obstetrics Physician
—
NULL
207VX0000X
Obstetrics Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
06/04/2018
Last updated
06/16/2018
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