Basic Information
| Provider Information | |||||||||
| NPI: | 1538243209 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTEFIORE MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | MMC TREMONT PRACTICE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 CORPORATE DR | ||||||||
| Address2: | MMC -CMO | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107016807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143786021 | ||||||||
| FaxNumber: | 9147090386 | ||||||||
| Practice Location | |||||||||
| Address1: | 3219 E TREMONT AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104615751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187928115 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 03/18/2009 | ||||||||
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| AuthorizedOfficialLastName: | DOWLING | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIR. OF PROV. SVCS. & NTWRK CONTRAC | ||||||||
| AuthorizedOfficialTelephone: | 9143774668 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.