Provider Demographics
NPI:1548548118
Name:CHILDRENS HOSPITAL AT MONTEFIORE
Entity type:Organization
Organization Name:CHILDRENS HOSPITAL AT MONTEFIORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-741-2467
Mailing Address - Street 1:3636 WALDO AVE
Mailing Address - Street 2:APT 4 P
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2247
Mailing Address - Country:US
Mailing Address - Phone:919-889-6521
Mailing Address - Fax:
Practice Address - Street 1:3415 BAINBRIDGE AVE
Practice Address - Street 2:ROSENTHAL 4
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2403
Practice Address - Country:US
Practice Address - Phone:718-741-2467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X281PC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281PC2000XHospitalsChronic Disease HospitalChildren