Healthcare Provider Details

I. General information

NPI: 1275710519
Provider Name (Legal Business Name): MONTEFIORE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST MMC DENTAL
BRONX NY
10467-2401
US

IV. Provider business mailing address

111 E 210TH ST MMC DENTAL
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4167
  • Fax:
Mailing address:
  • Phone: 718-920-4167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM SCESNEY
Title or Position: AVP
Credential:
Phone: 914-512-7929