MEDICARE: MONTEFIORE MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	281P00000X	Chronic Disease Hospital

General Provider Information

NPI Number	:	1629365580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTEFIORE MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1512 LIBRARY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-1110
Country	:	US
Telephone Number	:	347-365-0823
Fax Number	:

Provider Business Practice Location Address
First Line	:	1512 LIBRARY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-1110
Country	:	US
Telephone Number	:	347-365-0823
Fax Number	:

Authorized Official
Title or Position	:	PROFESSOR OF CLINICAL NEUROLOGY
Name	:	DR. SHERYL R HAUT
Credential	:	M.D.
Telephone Number	:	718-920-4898

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	06/29/2011

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