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General NPI Number Information
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NPI Number | 1497990121
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE PEDIATRICS ON CENTRAL AVENUE
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 1730 CENTRAL PARK AVE SUITE 1P
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City | YONKERS
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State | NY
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Zip | 10710-4905
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Country | US
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Telephone | 914-346-8999
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Fax | 914-346-8998
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Provider Business Mailing Address
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Address Line | 1730 CENTRAL PARK AVE SUITE 1P
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City | YONKERS
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State | NY
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Zip | 10710-4905
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Country | US
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Telephone | 914-346-8999
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Fax | 914-346-8998
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JANNETH MONTOYA
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Credential | M.D.
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Telephone | 914-346-8999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 226934
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 216114
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License Number State | NY
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