Healthcare Provider Details

I. General information

NPI: 1497990121
Provider Name (Legal Business Name): INTERNAL MEDICINE PEDIATRICS ON CENTRAL AVENUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 CENTRAL PARK AVE SUITE 1P
YONKERS NY
10710-4905
US

IV. Provider business mailing address

1730 CENTRAL PARK AVE SUITE 1P
YONKERS NY
10710-4905
US

V. Phone/Fax

Practice location:
  • Phone: 914-346-8999
  • Fax: 914-346-8998
Mailing address:
  • Phone: 914-346-8999
  • Fax: 914-346-8998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number216114
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number226934
License Number StateNY

VIII. Authorized Official

Name: DR. JANNETH MONTOYA
Title or Position: PARTNER
Credential: M.D.
Phone: 914-346-8999