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General NPI Number Information
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NPI Number | 1841406196
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Entity Type | Organization
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Legal Business Name | MONTEFIORRE MEDICAL CENTER
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 E 77TH ST BLACKHALL, 9TH FLOOR CARDIOLOGY
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City | NEW YORK
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State | NY
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Zip | 10021-1850
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Country | US
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Telephone | 212-434-2606
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Fax |
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Provider Business Mailing Address
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Address Line | 527 WANTAGH AVE
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City | WANTAGH
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State | NY
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Zip | 11793-2102
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Country | US
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Telephone | 631-871-4240
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MISS MARIA DEL CARMEN LEON
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Credential | PA
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Telephone | 631-871-4240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 010148-1
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License Number State | NY
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