Provider Demographics
NPI:1154644607
Name:MONTEFIORE MEDICAL CENTER
Entity Type:Organization
Organization Name:MONTEFIORE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR, DEPARTMENT OF MED
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOMBERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-920-9880
Mailing Address - Street 1:4315 WEBSTER AVE
Mailing Address - Street 2:1J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470
Mailing Address - Country:US
Mailing Address - Phone:917-226-6195
Mailing Address - Fax:
Practice Address - Street 1:4315 WEBSTER AVE
Practice Address - Street 2:1J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-2358
Practice Address - Country:US
Practice Address - Phone:917-226-6195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital