Healthcare Provider Details

I. General information

NPI: 1942667340
Provider Name (Legal Business Name): MONTEFIORE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 BAINBRIDGE MMC
BRONX NY
10467-2404
US

IV. Provider business mailing address

3400 BAINBRIDGE AVE # MMC
BRONX NY
10467-2404
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4646
  • Fax: 718-405-9014
Mailing address:
  • Phone: 718-920-4646
  • Fax: 718-405-9014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number019249-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number019240-1
License Number StateNY

VIII. Authorized Official

Name: JOHN LEONARD
Title or Position: DIRECTOR
Credential:
Phone: 718-920-8425