Basic Information
| Provider Information | |||||||||
| NPI: | 1205092129 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MONTEFIORE MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MMC NORTH AT STARLING AVENE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 CORPORATE DR | ||||||||
| Address2: | CMO | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107016807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143786163 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2115 STARLING AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104624307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188222810 | ||||||||
| FaxNumber: | 7188228732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2008 | ||||||||
| LastUpdateDate: | 07/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | DOWLING | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PROVIDER SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 9143774668 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.