# ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MOUNT SINAI SN HOSPITAL PHYSICIANS-RALI PET IDTF
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407470453
- **Authorized official:** ALICIA GRESHAM (VP NETWORK OPERATIONS)
- **Authorized official phone:** (212) 659-9038

## Contact information

- **Practice address:** 119 N PARK AVE, ROCKVILLE CENTRE, NY 11570-4113
- **Practice address phone:** (516) 255-9555
- **Mailing address:** 150 EAST 42ND STREET, 5TH FLOOR, 5.A.30.6, NEW YORK, NY 10017
- **Mailing address phone:** (646) 605-4113

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 293D00000X | Physiological Laboratory | — | NULL | Yes |

## Other

- **Enumeration date:** 06/05/2020
- **Last updated:** 06/05/2020