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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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