Healthcare Provider Details

I. General information

NPI: 1649514977
Provider Name (Legal Business Name): MONTEFIORE CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE 9TH FLOOR
BRONX NY
10467-2403
US

IV. Provider business mailing address

3415 BAINBRIDGE AVE 9TH FLOOR
BRONX NY
10467-2403
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2100
  • Fax:
Mailing address:
  • Phone: 718-741-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License NumberF337153-1
License Number StateNY

VIII. Authorized Official

Name: DR. RICHARD GORLICK
Title or Position: VICE CHAIRMAN, DEPARTMENT OF PEDIAT
Credential: M.D.
Phone: 718-741-2342