Provider Demographics
NPI:1639309982
Name:MONTEFIORE MEDICAL CENTER
Entity Type:Organization
Organization Name:MONTEFIORE MEDICAL CENTER
Other - Org Name:MMC AECOM SUBSTANCE ABUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIR. OF PROVIDER SERVICES & NETW
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
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 1:1754 RANDALL AVENUE
Mailing Address - Street 2:MMC AECOM SUBSTANCE ABUSE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473
Mailing Address - Country:US
Mailing Address - Phone:718-920-4321
Mailing Address - Fax:
Practice Address - Street 1:1754 RANDALL AVENUE
Practice Address - Street 2:MMC AECOM SUBSTANCE ABUSE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473
Practice Address - Country:US
Practice Address - Phone:718-920-4321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty