Healthcare Provider Details

I. General information

NPI: 1972315869
Provider Name (Legal Business Name): MONTEFIORE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 E BOSTON POST RD STE 101
MAMARONECK NY
10543-3704
US

IV. Provider business mailing address

100 CORPORATE DR
YONKERS NY
10701-6807
US

V. Phone/Fax

Practice location:
  • Phone: 914-510-7005
  • Fax: 914-930-4207
Mailing address:
  • Phone: 914-378-6148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOHN M PREOLO
Title or Position: SENIOR DIRECTOR, CREDENTIALING
Credential:
Phone: 914-608-5063