# MOUNT SINAI SCHOOL OF MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mount Sinai Marathon Medical - Gastroenterology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356818553
- **Authorized official:** ALICIA GRESHAM (VP NETWORK OPERATIONS)
- **Authorized official phone:** (212) 659-9038

## Contact information

- **Practice address:** 2965 LONG BEACH RD, OCEANSIDE, NY 11572-3255
- **Practice address phone:** (516) 992-5626
- **Mailing address:** 2965 LONG BEACH RD, OCEANSIDE, NY 11572-3255
- **Mailing address phone:** (516) 992-5626

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RG0100X | Gastroenterology Physician | — | NULL | Yes |
| 207RG0100X | Gastroenterology Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 10/26/2018
- **Last updated:** 01/11/2019