# ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MOUNT SINAI DOCTORS SOUTH NASSAU - MFM
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720570922
- **Authorized official:** ALICIA GRESHAM (VP OF NETWORK OPERATIONS)
- **Authorized official phone:** (212) 659-9038

## Contact information

- **Practice address:** 196 MERRICK RD, OCEANSIDE, NY 11572
- **Practice address phone:** (516) 255-8400
- **Mailing address:** 196 MERRICK RD, OCEANSIDE, NY 11572-1420

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207VM0101X | Maternal & Fetal Medicine Physician | — | NULL | Yes |
| 207VM0101X | Maternal & Fetal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/04/2018
- **Last updated:** 06/08/2018