Provider Demographics
NPI:1033270640
Name:MONTEFIORE MEDICAL CENTER
Entity Type:Organization
Organization Name:MONTEFIORE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHUCA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-991-0605
Mailing Address - Street 1:11215 72ND RD
Mailing Address - Street 2:APARTMENT 505
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4663
Mailing Address - Country:US
Mailing Address - Phone:917-705-2710
Mailing Address - Fax:
Practice Address - Street 1:871 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3913
Practice Address - Country:US
Practice Address - Phone:718-991-0605
Practice Address - Fax:718-991-2931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227890261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health