Healthcare Provider Details

I. General information

NPI: 1548548118
Provider Name (Legal Business Name): CHILDRENS HOSPITAL AT MONTEFIORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE ROSENTHAL 4
BRONX NY
10467-2403
US

IV. Provider business mailing address

3636 WALDO AVE APT 4 P
BRONX NY
10463-2247
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2467
  • Fax:
Mailing address:
  • Phone: 919-889-6521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number390200000X
License Number StateNY

VIII. Authorized Official

Name: DR. SARA ROSS
Title or Position: PROGRAM DIRECTOR
Credential: M.D.
Phone: 718-741-2467