# ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI

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

## Provider details

- **NPI number:** 1578817540
- **Authorized official:** DR. MARTIN J FINE MD (DIRECTOR, FACULTY PRACTICE GROUP)
- **Authorized official phone:** (718) 334-1591

## Contact information

- **Practice address:** 7901 BROADWAY, ELMHURST, NY 11373-1329
- **Practice address phone:** (718) 334-1591
- **Practice address fax:** (718) 334-4815
- **Mailing address:** 7901 BROADWAY, ELMHURST, NY 11373-1329
- **Mailing address phone:** (718) 334-1591
- **Mailing address fax:** (718) 334-4815

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |
| 207VE0102X | Reproductive Endocrinology Physician | — | NULL | — |
| 207VE0102X | Reproductive Endocrinology Physician | — | — | — |
| 207VF0040X | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician | — | NULL | — |
| 207VF0040X | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician | — | — | — |
| 207VM0101X | Maternal & Fetal Medicine Physician | — | NULL | — |
| 207VM0101X | Maternal & Fetal Medicine Physician | — | — | — |
| 207VX0201X | Gynecologic Oncology Physician | — | NULL | — |
| 207VX0201X | Gynecologic Oncology Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |

## Other

- **Enumeration date:** 10/30/2012
- **Last updated:** 02/19/2019