Organization
MOUNT SINAI SCHOOL OF MEDICINE
Active
Other names
Mount Sinai Marathon Medical - Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA GRESHAM (VP NETWORK OPERATIONS)
(212) 659-9038
Entity
Organization
Contact information
Practice address
196 MERRICK RD, OCEANSIDE, NY 11572-1420
(516) 255-8400
Mailing address
155 W MERRICK RD, FREEPORT, NY 11520-3743
(516) 379-3139
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
208600000X
Surgery Physician
Primary
—
—
2086S0102X
Surgical Critical Care Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
2086S0127X
Trauma Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
2086X0206X
Surgical Oncology Physician
—
—
208800000X
Urology Physician
—
—
2088F0040X
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
—
—
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
364SM0705X
Medical-Surgical Clinical Nurse Specialist
—
—
Other
Enumeration date
10/25/2018
Last updated
01/11/2019
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