NPIMap

Organization Active NPI

Mount Sinai School of Medicine

  • Body Imaging Physician
  • Oceanside, NY
National Provider Identifier
1396212536
Registry record updated Jan 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Body Imaging PhysicianTaxonomy code 2085B0100X
Legal business name
MOUNT SINAI SCHOOL OF MEDICINE
Practice address
1 Healthy Way
Oceanside, NY 11572-1551
Phone
(516) 632-3921
NPI assigned
Oct 25, 2018
Last updated
Jan 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alicia Gresham
Title
VP Network Operations
Phone
(212) 659-9038

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X Primary
Nuclear Radiology Physician 2085N0904X
Diagnostic Radiology Physician 2085R0202X
Vascular & Interventional Radiology Physician 2085R0204X

Addresses

Primary practice location

1 Healthy Way
Oceanside, NY 11572-1551

Mailing address

119 N Park Ave Ste 101
Rockville Centre, NY 11570-4113
Phone (516) 255-9555

Other practice location 1

440 Merrick Rd
Oceanside, NY 11572-1404
Phone (516) 255-8220

Other practice location 2

185 Merrick Rd
Oceanside, NY 11572-1431
Phone (516) 632-3921

Other practice location 3

119 N Park Ave Ste 101
Rockville Centre, NY 11570-4113
Phone (516) 255-9555

Other names 1

  • Mount Sinai Marathon Medical - Radiology Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130712000368 NY Part B Supplier - Clinic/Group Practice 6406096544 Receives reassigned benefits from 385 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lynbrook, NY; Long Beach, NY; Manhasset, NY; Merrick, NY; New York, NY; Oceanside, NY; Rockville Centre, NY; Valley Stream, NY…

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Mount Sinai Marathon Medical - Idtf18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Locations

119 N Park Ave
Ste 101
Rockville Ctr, NY 11570
Phone (516) 255-9555

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547164800000",
    "number": "1396212536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 N PARK AVE STE 101",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115704113",
            "telephone_number": "516-255-9555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HEALTHY WAY",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115721551",
            "telephone_number": "516-632-3921"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "440 Merrick Rd",
            "address_purpose": "LOCATION",
            "city": "Oceanside",
            "state": "NY",
            "postal_code": "115721404",
            "country_code": "US",
            "telephone_number": "516-255-8220",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "185 Merrick Rd",
            "address_purpose": "LOCATION",
            "city": "Oceanside",
            "state": "NY",
            "postal_code": "115721431",
            "country_code": "US",
            "telephone_number": "516-632-3921",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "119 N Park Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Rockville Centre",
            "state": "NY",
            "postal_code": "115704113",
            "country_code": "US",
            "telephone_number": "516-255-9555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MOUNT SINAI SCHOOL OF MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-25",
        "last_updated": "2019-01-11",
        "status": "A",
        "authorized_official_last_name": "GRESHAM",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "VP NETWORK OPERATIONS",
        "authorized_official_telephone_number": "212-659-9038"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mount Sinai Marathon Medical - Radiology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Oceanside, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.