Provider Demographics
NPI:1497990121
Name:INTERNAL MEDICINE PEDIATRICS ON CENTRAL AVENUE
Entity Type:Organization
Organization Name:INTERNAL MEDICINE PEDIATRICS ON CENTRAL AVENUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-346-8999
Mailing Address - Street 1:1730 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE 1P
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-4905
Mailing Address - Country:US
Mailing Address - Phone:914-346-8999
Mailing Address - Fax:914-346-8998
Practice Address - Street 1:1730 CENTRAL PARK AVE
Practice Address - Street 2:SUITE 1P
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-4905
Practice Address - Country:US
Practice Address - Phone:914-346-8999
Practice Address - Fax:914-346-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216114207R00000X
NY226934208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty