To become an IPA member, please complete and submit the form below. If you are already a member or employed by the Icahn School of Medicine, you do NOT need to submit the form. Instead, please inquire about membership within your department.

  • Do you have Hospital Admitting Privileges at any of the following Mount Sinai System Campuses? (Check all that apply).

    • If you are in a group practice and bill under the same TIN, all associated practice physicians must join The Mount Sinai IPA. No exceptions will be made.
    • All physicians must have visiting/attending privileges in writing at Mount Sinai System Campuses.
    • Please contact the MSH Medical Staff Office to inquire about physician privileges (212-241-6500).

  • List all associated physicians in the available space below.

  • Office Contact