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General NPI Number Information
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NPI Number | 1366653974
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Entity Type | Organization
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Legal Business Name | MONTEFIORE MEDICAL CENTER
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 03/17/2009
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Provider Practice Location Address
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Address Line | 48 UNION AVE
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City | AMITYVILLE
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State | NY
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Zip | 11701-3024
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Country | US
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Telephone | 631-532-5002
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Fax |
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Provider Business Mailing Address
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Address Line | 48 UNION AVE
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City | AMITYVILLE
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State | NY
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Zip | 11701-3024
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Country | US
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Telephone | 631-532-5002
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Fax |
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Authorized Official
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Title or Position | CRITICAL CARE PHYSICIAN ASSISTANT
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Name | MRS. MICHELLE DAWN LAZOS
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Credential | PA
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Telephone | 718-904-3415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number |
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License Number State |
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