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Organization
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Active
Organization
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Active
Other names
MOUNT SINAI DOCTORS SOUTH NASSAU - INTERNAL /FAMILY MEDICINE, MOUNT SINAI DOCTORS SOUTH NASSAU - INTERNAL/FAMILY MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA GRESHAM (VP OF NETWORK OPERATIONS)
(212) 659-9038
Entity
Organization
Contact information
Practice address
196 MERRICK RD, OCEANSIDE, NY 11572
(516) 255-8400
Mailing address
1 HEALTHY WAY, OCEANSIDE, NY 11572-1551
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QB0002X
Obesity Medicine (Family Medicine) Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Enumeration date
06/01/2018
Last updated
06/16/2018
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