MEDICARE: DR. MONTE EZRATTY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	146894	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88D011	OTHER	NY	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427009331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONTE EZRATTY M.D.

Provider Business Mailing Address
First Line	:	1545 UNIONPORT RD
Second Line	:	PARK SOUTH MEDICAL
City	:	BRONX
State	:	NY
Zip	:	10462-7714
Country	:	US
Telephone Number	:	718-892-2201
Fax Number	:	718-828-9663

Provider Business Practice Location Address
First Line	:	1545 UNIONPORT RD
Second Line	:	PARK SOUTH MEDICAL
City	:	BRONX
State	:	NY
Zip	:	10462-7714
Country	:	US
Telephone Number	:	718-892-2201
Fax Number	:	718-828-9663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	01/03/2008

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