Provider Demographics
NPI:1841406196
Name:MONTEFIORRE MEDICAL CENTER
Entity Type:Organization
Organization Name:MONTEFIORRE MEDICAL CENTER
Other - Org Name:LENOX HILL HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIA DEL CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:631-871-4240
Mailing Address - Street 1:527 WANTAGH AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2102
Mailing Address - Country:US
Mailing Address - Phone:631-871-4240
Mailing Address - Fax:
Practice Address - Street 1:100 E 77TH ST
Practice Address - Street 2:BLACKHALL, 9TH FLOOR CARDIOLOGY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1850
Practice Address - Country:US
Practice Address - Phone:212-434-2606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010148-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty