NPIMap

Organization Active NPI

Icahn School of Medicine at Mount Sinai

Doing business as Mount Sinai Elmhurst Faculty Practice Group

  • Obstetrics & Gynecology Physician
  • Elmhurst, NY
National Provider Identifier
1578817540
Registry record updated Feb 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Doing business as
Mount Sinai Elmhurst Faculty Practice Group
Mount Sinai School of Medicine
Practice address
7901 Broadway
Elmhurst, NY 11373-1329
Phone
(718) 334-1591
Fax
(718) 334-4815
NPI assigned
Oct 30, 2012
Last updated
Feb 19, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2019

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

Authorized official

Name
Dr. Martin J Fine, MDNPI 1013025345
Title
Director, Faculty Practice Group
Phone
(718) 334-1591

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X Primary
Reproductive Endocrinology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VE0102X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VF0040X
Maternal & Fetal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VM0101X
Gynecologic Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VX0201X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X

Addresses

Primary practice location

7901 Broadway
Elmhurst, NY 11373-1329

Mailing address

7901 Broadway
Elmhurst, NY 11373-1329
Phone (718) 334-1591

Other names 2

  • Mount Sinai Elmhurst Faculty Practice Group Doing business as
  • Mount Sinai School of Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130205000439 NY Part B Supplier - Clinic/Group Practice 8224282926 Receives reassigned benefits from 827 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Point, NY; Poughkeepsie, NY; New York, NY; Elmhurst, 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
Mt Sinai Elmhurst Fac Prac15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 154

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 154

NPI Registry JSON

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550534400000",
    "number": "1578817540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7901 BROADWAY",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113731329",
            "telephone_number": "718-334-1591",
            "fax_number": "718-334-4815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7901 BROADWAY",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113731329",
            "telephone_number": "718-334-1591",
            "fax_number": "718-334-4815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-30",
        "last_updated": "2019-02-19",
        "status": "A",
        "authorized_official_last_name": "FINE",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR, FACULTY PRACTICE GROUP",
        "authorized_official_telephone_number": "718-334-1591",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207VE0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mount Sinai Elmhurst Faculty Practice Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mount Sinai School of Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mount Sinai School of Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elmhurst, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 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.