Organization
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD PETERSON (CBO DIRECTOR OF OPERATIONS)
(646) 605-8145
Entity
Organization
Contact information
Practice address
445 E 77TH ST, NEW YORK, NY 10075-2318
(212) 772-3900
Mailing address
150 E 42ND ST FL 10, NEW YORK, NY 10017-5626
(646) 605-8119
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208800000X
Urology Physician
Primary
—
—
2088F0040X
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
—
—
2088P0231X
Pediatric Urology Physician
—
—
Other
Enumeration date
11/20/2017
Last updated
11/20/2017
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