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	261QS1000X	Student Health Clinic/Center

General Provider Information

NPI Number	:	1841099710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTEFIORE MEDICAL CENTER

Provider Business Mailing Address
First Line	:	100 CORPORATE DR STE 100
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10701-6807
Country	:	US
Telephone Number	:	914-378-6148
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 FULTON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-7546
Country	:	US
Telephone Number	:	718-292-0578
Fax Number	:

Authorized Official
Title or Position	:	SENIOR DIRECTOR, CREDENTIALING
Name	:	JOHN M PREOLO
Credential	:
Telephone Number	:	914-608-5063

Provider Enumeration Date	:	03/12/2025
Last Update Date	:	03/12/2025

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