Provider Demographics
NPI:1053357533
Name:MOUNT SINAI REHABILITATION HOSPITAL, INC.
Entity type:Organization
Organization Name:MOUNT SINAI REHABILITATION HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-714-2614
Mailing Address - Street 1:114 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1208
Mailing Address - Country:US
Mailing Address - Phone:860-714-4000
Mailing Address - Fax:
Practice Address - Street 1:490 BLUE HILLS AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1513
Practice Address - Country:US
Practice Address - Phone:860-714-4953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH OF NEW ENGLAND CORPORATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-21
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT17CD283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4147717Medicaid
CT358444OtherWELLCARE
CTH433125OtherOXFORD
CT358444OtherWELLCARE
CT4147717Medicaid