NPIMap

Organization Active NPI

Icahn School of Medicine at Mount Sinai

Doing business as Mt Sinai Doctors Si-Victory Int Med

  • Internal Medicine Physician
  • Staten Island, NY
National Provider Identifier
1447640024
Registry record updated Jan 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Doing business as
Mt Sinai Doctors Si-Victory Int Med
Practice address
2315 Victory Blvd
Staten Island, NY 10314-6623
Phone
(718) 477-6900
NPI assigned
Feb 3, 2015
Organization subpart
Yes
Parent organization
MOUNT SINAI HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 17, 2020

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

2315 Victory Blvd
Staten Island, NY 10314-6623

Mailing address

2315 Victory Blvd
Staten Island, NY 10314-6623
Phone (718) 477-6900

Other practice location 1

4982 Hylan Blvd
Staten Island, NY 10312-6399
Phone (718) 477-6900

Other names 1

  • MT SINAI DOCTORS SI-VICTORY INT MED Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150413000693 NY Part B Supplier - Clinic/Group Practice 8921326570 Receives reassigned benefits from 8 practitioners
Practice locations: Staten Island, NY

National Provider Directory

National Provider Directory
Part of
Mt Sinai Hospital of Qu

Locations

4982 Hylan Blvd
Staten Island, NY 10312
Phone (718) 477-6900

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1422921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579219200000",
    "number": "1447640024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2315 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146623",
            "telephone_number": "718-477-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2315 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146623",
            "telephone_number": "718-477-6900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4982 Hylan Blvd",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103126399",
            "country_code": "US",
            "telephone_number": "718-477-6900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNT SINAI HOSPITAL",
        "enumeration_date": "2015-02-03",
        "last_updated": "2020-01-17",
        "certification_date": "2020-01-17",
        "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": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MT SINAI DOCTORS SI-VICTORY INT MED",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MT SINAI DOCTORS SI-VICTORY INT MED",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2020; 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.