=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962849869
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONTEFIORE MEDCIAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2013
-----------------------------------------------------
Last Update Date | 05/31/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4256 BRONX BLVD
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10466-2672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-329-8200
-----------------------------------------------------
Fax | 646-329-8210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4256 BRONX BLVD
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10466-2672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-329-8200
-----------------------------------------------------
Fax | 646-329-8210
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF ADMINISTRATIVE OFFICER
-----------------------------------------------------
Name | MICHAEL DOWLING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 914-377-4668
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------