Provider Demographics
NPI:1952547606
Name:MONTEFIORE MEDICAL CENTER
Entity Type:Organization
Organization Name:MONTEFIORE MEDICAL CENTER
Other - Org Name:MMC FAMILY MEDICINE AT JEROME
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PROV. SERVICES AND 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 1:100 CORPORATE DR
Mailing Address - Street 2:CMO
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-6807
Mailing Address - Country:US
Mailing Address - Phone:914-377-4722
Mailing Address - Fax:914-709-0386
Practice Address - Street 1:3544 JEROME AVE
Practice Address - Street 2:MMC FAMILY MEDICINE AT JEROME
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1005
Practice Address - Country:US
Practice Address - Phone:718-920-5521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW73371Medicare PIN
NYWLW981Medicare PIN