# ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mount Sinai Elmhurst Faculty Practice Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346721289
- **Authorized official:** ANNE HOGAN (ADMINISTRATOR)
- **Authorized official phone:** (718) 334-4952

## Contact information

- **Practice address:** 7901 BROADWAY RM A1-19, ELMHURST, NY 11373-1329
- **Practice address phone:** (718) 334-4816
- **Mailing address:** 7901 BROADWAY RM A1-19, ELMHURST, NY 11373-1329
- **Mailing address phone:** (718) 334-4816

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/28/2018
- **Last updated:** 08/28/2018