Provider Demographics
NPI:1427009331
Name:EZRATTY, MONTE (MD)
Entity Type:Individual
Prefix:DR
First Name:MONTE
Middle Name:
Last Name:EZRATTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 UNIONPORT RD
Mailing Address - Street 2:PARK SOUTH MEDICAL
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7714
Mailing Address - Country:US
Mailing Address - Phone:718-892-2201
Mailing Address - Fax:718-828-9663
Practice Address - Street 1:1545 UNIONPORT RD
Practice Address - Street 2:PARK SOUTH MEDICAL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-7714
Practice Address - Country:US
Practice Address - Phone:718-892-2201
Practice Address - Fax:718-828-9663
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY88D011OtherBC/BS
NY00977459Medicaid
NY00977459Medicaid
NY88D011OtherBC/BS