Provider Demographics
NPI:1831457894
Name:MONTEFIORE
Entity Type:Organization
Organization Name:MONTEFIORE
Other - Org Name:ALBERT EINSTEIN COLLEGE OF MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTAL RESIDENCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-920-6039
Mailing Address - Street 1:839 CALLE ANASCO APT 424
Mailing Address - Street 2:PLAZA UNIVERSIDAD 2000
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-2453
Mailing Address - Country:US
Mailing Address - Phone:787-460-7877
Mailing Address - Fax:
Practice Address - Street 1:111 EAST 210TH STREET
Practice Address - Street 2:MONTEFIORE MEDICAL CENTER DEPARTMENT OF DENTISTRY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-9998
Practice Address - Country:US
Practice Address - Phone:718-920-6039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health