Healthcare Provider Details

I. General information

NPI: 1366653974
Provider Name (Legal Business Name): MONTEFIORE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 UNION AVE
AMITYVILLE NY
11701-3024
US

IV. Provider business mailing address

48 UNION AVE
AMITYVILLE NY
11701-3024
US

V. Phone/Fax

Practice location:
  • Phone: 631-532-5002
  • Fax:
Mailing address:
  • Phone: 631-532-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE DAWN LAZOS
Title or Position: CRITICAL CARE PHYSICIAN ASSISTANT
Credential: PA
Phone: 718-904-3415