Affiliation Verification Lookup Portal
Providers for Mount Sinai Health System
Mount Sinai Beth Israel
Mount Sinai Brooklyn
Mount Sinai Hospital
Mount Sinai Morningside
Mount Sinai Queens
Mount Sinai West
New York Eye and Ear Infirmary
-- All Facilities --
Provider Last Name
Last name is required.
Provider First Name
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Provider NPI
NPI is required.
NPI number is invalid. Must be a ten-digit number.
Required Information
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Requester Name
Name is required.
Requester Title
Title is required.
Requester Organization
Organization is required.
Requester Address
Address is required.
Requester City, State, Zip
City, State, Zip is required.
Requester Phone
Phone is required.
Requester Email
Email is required.
I agree and acknowledge that I possess a signed release and immunity statement signed by the practitioner for which I am obtaining hospital verification information. Such signed release and immunity holds harmless and indemnifies Mount Sinai Health System and individuals providing information pursuant to this request, its medical staff, board of directors and each of their respective members and designees, the administration of such Mount Sinai Health System and its directors, officers, employees, representatives and agents, and each of them from any and all claims, demands or actions with respect to all acts, including without limitation, communications, reports, recommendations, or disclosures performed or made in connection with the request for the release of information pertaining to the practitioner's hospital affiliation with Mount Sinai Health System. **** If "No Results Found" - Please send a copy of Verification and Release to the Medical Staff Office at MSS-Intake@mountsinai.org
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Please Enter the Following Information:
Provider Last Name
Provider First Name
Provider NPI
Requester Name
Requester Title
Requester Organization
Requester Address
Requester City, State, Zip
Requester Phone
Requester Email