Provider Demographics
NPI:1235401241
Name:MONTEFIORE MEDICAL CENTER
Entity Type:Organization
Organization Name:MONTEFIORE MEDICAL CENTER
Other - Org Name:MMC AT 148TH STREET
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF ADMININSTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICAHEL
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 1:334 E 148TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5707
Mailing Address - Country:US
Mailing Address - Phone:718-401-5050
Mailing Address - Fax:718-401-5080
Practice Address - Street 1:334 E 148TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5707
Practice Address - Country:US
Practice Address - Phone:718-401-5050
Practice Address - Fax:718-401-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWLW981Medicare PIN