Provider Demographics
NPI:1023362449
Name:MONTEFIORE MEDICAL CENTER
Entity Type:Organization
Organization Name:MONTEFIORE MEDICAL CENTER
Other - Org Name:MMC AT 182 EAST 210TH
Other - Org Type:Other Name
Authorized Official - Title/Position:CJIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:DOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-377-4668
Mailing Address - Street 1:100 CORPORATE DR
Mailing Address - Street 2:CMO- PROVIDER INFORMATION
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-6807
Mailing Address - Country:US
Mailing Address - Phone:718-405-8444
Mailing Address - Fax:718-405-8345
Practice Address - Street 1:100 CORPORATE DR
Practice Address - Street 2:CMO- PROVIDER INFORMATION
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-6807
Practice Address - Country:US
Practice Address - Phone:718-405-8444
Practice Address - Fax:718-405-8345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWLW981Medicare PIN