Provider Demographics
NPI:1366653974
Name:MONTEFIORE MEDICAL CENTER
Entity Type:Organization
Organization Name:MONTEFIORE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRITICAL CARE PHYSICIAN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:LAZOS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:718-904-3415
Mailing Address - Street 1:48 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3024
Mailing Address - Country:US
Mailing Address - Phone:631-532-5002
Mailing Address - Fax:
Practice Address - Street 1:48 UNION AVE
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3024
Practice Address - Country:US
Practice Address - Phone:631-532-5002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access