Basic Information
| Provider Information | |||||||||
| NPI: | 1922779016 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTEFIORE MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 CORPORATE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107016807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143774772 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1250 WATERS PL STE 501A | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184099444 | ||||||||
| FaxNumber: | 7184090236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2021 | ||||||||
| LastUpdateDate: | 09/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | DOWLING | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 9143774668 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.