Healthcare Provider Details

I. General information

NPI: 1336427574
Provider Name (Legal Business Name): MONTEFIORE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

IV. Provider business mailing address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number282NC2000X
License Number StateNY

VIII. Authorized Official

Name: DR. SARA ROSS
Title or Position: RESIDENCY PROGRAM DIRECTOR
Credential:
Phone: 719-741-2453