Healthcare Provider Details

I. General information

NPI: 1790060606
Provider Name (Legal Business Name): MONTEFIORE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 PROSPECT AVE
BRONX NY
10459-3978
US

IV. Provider business mailing address

890 PROSPECT AVE
BRONX NY
10459-3978
US

V. Phone/Fax

Practice location:
  • Phone: 718-991-0605
  • Fax: 347-498-2751
Mailing address:
  • Phone: 718-991-0605
  • Fax: 347-498-2751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL G. DOWLING
Title or Position: CHIEF ADMINSTRATIVE OFFICE
Credential:
Phone: 914-377-4668