1205963972 NPI number — MONTEFIORE MEDICAL CENTER-MONTEFIORE PHARMACY

Table of content: (NPI 1205963972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205963972 NPI number — MONTEFIORE MEDICAL CENTER-MONTEFIORE PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTEFIORE MEDICAL CENTER-MONTEFIORE PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MONTEFIORE PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205963972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 E 210TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10467-2401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-920-5194
Provider Business Mailing Address Fax Number:
718-652-0733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3444 KOSSUTH AVE
Provider Second Line Business Practice Location Address:
GROUND FLOOR
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10467-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-920-4300
Provider Business Practice Location Address Fax Number:
718-652-0733
Provider Enumeration Date:
02/28/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TUCKMAN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
718-920-4300

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  000475 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 000475 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336I0012X , with the licence number: 000475 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 032128 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".