NPIMap

Organization Active NPI

Icahn School of Medicine at Mount Sinai

Doing business as Cardiothoracic Surgery of Mount Sinai

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • New York, NY
National Provider Identifier
1750626560
Registry record updated Jul 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Doing business as
Cardiothoracic Surgery of Mount Sinai
Practice address
1190 5TH Ave
Box 1028
New York, NY 10029-6503
Phone
(212) 241-5646
Fax
(212) 241-0038
NPI assigned
Dec 5, 2012
Last updated
Jul 8, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2015

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

Authorized official

Name
Crystal Macneill
Title
VP, Cbo Director
Phone
(646) 605-8112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X Primary

Addresses

Primary practice location

1190 5TH Ave
Box 1028
New York, NY 10029-6503

Mailing address

150 East 42ND. Street
10TH FL.
New York, NY 10017-5626
Phone (646) 605-8119

Other names 1

  • Cardiothoracic Surgery of Mount Sinai Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20121218000412 NY Part B Supplier - Clinic/Group Practice 2264691070 Receives reassigned benefits from 84 practitioners
Practice locations: Valhalla, NY; Staten Island, NY; New York, NY; Long Island, NY; Flushing, NY
O20131018001625 NJ Part B Supplier - Clinic/Group Practice 2264691070 Receives reassigned benefits from 19 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Paramus, NJ; Teaneck, NJ; Ridgewood, NJ; Long Branch, NY; Englewood Cliffs, NJ; Englewood, NJ; Edgewater, NJ; Berkeley Heights, NJ…

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory

Locations

14004 58th Rd
Flushing, NY 11355
Phone (718) 463-4155

Practitioners & affiliated clinicians

Practitioners 89

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 89

NPI Registry JSON

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

{
    "created_epoch": "1354665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436313600000",
    "number": "1750626560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 EAST 42ND. STREET",
            "address_2": "10TH FL.",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100175626",
            "telephone_number": "646-605-8119",
            "fax_number": "646-605-3029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 5TH AVE",
            "address_2": "BOX 1028",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296503",
            "telephone_number": "212-241-5646",
            "fax_number": "212-241-0038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-05",
        "last_updated": "2015-07-08",
        "status": "A",
        "authorized_official_last_name": "MACNEILL",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "VP, CBO DIRECTOR",
        "authorized_official_telephone_number": "646-605-8112"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cardiothoracic Surgery of Mount Sinai",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2015; 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.