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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1952547606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTEFIORE MEDICAL CENTER

Provider Business Mailing Address
First Line	:	100 CORPORATE DR
Second Line	:	CMO
City	:	YONKERS
State	:	NY
Zip	:	10701-6807
Country	:	US
Telephone Number	:	914-377-4722
Fax Number	:	914-709-0386

Provider Business Practice Location Address
First Line	:	3544 JEROME AVE
Second Line	:	MMC FAMILY MEDICINE AT JEROME
City	:	BRONX
State	:	NY
Zip	:	10467-1005
Country	:	US
Telephone Number	:	718-920-5521
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PROV. SERVICES AND NETW
Name	:	MICHAEL G DOWLING
Credential	:
Telephone Number	:	914-377-4668

Provider Enumeration Date	:	12/31/2008
Last Update Date	:	12/31/2008

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Directions to “MONTEFIORE MEDICAL CENTER ” Practice Location

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