NPIMap

Organization Active NPI

Icahn School of Medicine at Mount Sinai

  • Diagnostic Radiology Physician
  • Oceanside, NY
National Provider Identifier
1548752504
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Practice address
185 Merrick Rd
Oceanside, NY 11572-1431
Phone
(516) 766-6550
NPI assigned
Jun 5, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0202X Primary
Vascular & Interventional Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0204X

Addresses

Primary practice location

185 Merrick Rd
Oceanside, NY 11572-1431

Mailing address

185 Merrick Rd
Oceanside, NY 11572-1431

Other practice location 1

1 Healthy Way
Oceanside, NY 11572-1551
Phone (516) 766-6550

Other practice location 2

440 Merrick Rd
Oceanside, NY 11572-1404
Phone (516) 766-6550

Other names 2

  • MOUNT SINAI DOCTORS SOUTH NASSAU-RADIOLOGY Other name
  • RADIOLOGY AT MOUNT SINAI DOCTORS SOUTH NASSAU Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2094407Mount Sinai Doctors - Oceanside, Radiology185 Merrick Road, Oceanside, NY 11572Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Icahn School of Medicine at Mount Sinai8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

NPI Registry JSON

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

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1548752504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 MERRICK RD",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115721431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 MERRICK RD",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115721431",
            "telephone_number": "516-766-6550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Healthy Way",
            "address_purpose": "LOCATION",
            "city": "Oceanside",
            "state": "NY",
            "postal_code": "115721551",
            "country_code": "US",
            "telephone_number": "516-766-6550",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "440 Merrick Rd",
            "address_purpose": "LOCATION",
            "city": "Oceanside",
            "state": "NY",
            "postal_code": "115721404",
            "country_code": "US",
            "telephone_number": "516-766-6550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-05",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "GRESHAM",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "VP OF NETWORK OPERATIONS",
        "authorized_official_telephone_number": "212-659-9038"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOUNT SINAI DOCTORS SOUTH NASSAU-RADIOLOGY",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "MOUNT SINAI DOCTORS SOUTH NASSAU-RADIOLOGY",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "RADIOLOGY AT MOUNT SINAI DOCTORS SOUTH NASSAU",
            "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 Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.