Basic Information
| Provider Information | |||||||||
| NPI: | 1265591168 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTEFIORE MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 FORDHAM PLAZA | ||||||||
| Address2: | SUITE 1100 | ||||||||
| City: | BRONX | ||||||||
| State: | NM | ||||||||
| PostalCode: | 10458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184054400 | ||||||||
| FaxNumber: | 7183647365 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 FORDHAM PLZ RM 1100 | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104585871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184054400 | ||||||||
| FaxNumber: | 7183647365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 05/06/2019 | ||||||||
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| AuthorizedOfficialLastName: | MENASHY | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT, FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 7189204686 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 7000606 | NY | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 00243554 | 05 | NY | MEDICAID |