NPIMap

Organization Active NPI

North Shore Medical Group of the Mount Sinai School of Medicine

Doing business as North Shore Medical Group

  • Family Medicine Physician
  • Hewlett, NY
National Provider Identifier
1669854824
Registry record updated Jun 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTH SHORE MEDICAL GROUP OF THE MOUNT SINAI SCHOOL OF MEDICINE
Doing business as
North Shore Medical Group
Practice address
1436 Broadway
Hewlett, NY 11557-1405
Phone
(929) 210-6570
Fax
(929) 210-6571
NPI assigned
Jun 24, 2015
Last updated
Jun 24, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
MOUNT SINAI MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 24, 2015

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

Authorized official

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Pediatric Adolescent Medicine Physician 2080A0000X NU

Addresses

Primary practice location

1436 Broadway
Hewlett, NY 11557-1405

Mailing address

1436 Broadway
Hewlett, NY 11557-1405
Phone (929) 210-6570

Other names 1

  • North Shore Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
North Shore Medical Group10 organizations share this tax ID, including this one
Part of
Mount Sinai Hospital

Other organizations with this tax ID 9

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": "1435104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435104000000",
    "number": "1669854824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1436 BROADWAY",
            "city": "HEWLETT",
            "state": "NY",
            "postal_code": "115571405",
            "telephone_number": "929-210-6570",
            "fax_number": "929-210-6571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1436 BROADWAY",
            "city": "HEWLETT",
            "state": "NY",
            "postal_code": "115571405",
            "telephone_number": "929-210-6570",
            "fax_number": "929-210-6571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE MEDICAL GROUP OF THE MOUNT SINAI SCHOOL OF MEDICINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNT SINAI MEDICAL CENTER",
        "enumeration_date": "2015-06-24",
        "last_updated": "2015-06-24",
        "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",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Shore Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hewlett, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.