Basic Information
| Provider Information | |||||||||
| NPI: | 1164699070 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MONTEFIORE MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | MMC FERTILITY AND HORMONE CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 S CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | HARTSDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105302319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149971060 | ||||||||
| FaxNumber: | 9147090386 | ||||||||
| Practice Location | |||||||||
| Address1: | 141 S CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | HARTSDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105302319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149971060 | ||||||||
| FaxNumber: | 9147090386 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2008 | ||||||||
| LastUpdateDate: | 04/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | DOWLING | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9143786488 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.