NPIMap

Organization Active NPI

Montefiore Medical Center

  • Anesthesiology Physician
  • Bronx, NY
National Provider Identifier
1063525152
Registry record updated Mar 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
MONTEFIORE MEDICAL CENTER
Practice address
111 E 210TH St
Bronx, NY 10467-2401
Phone
(914) 378-6021
Fax
(914) 709-0386
NPI assigned
Aug 16, 2006
Last updated
Mar 18, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MONTEFIORE MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John M Preolo
Title
Sr Director Provider Credentialing
Phone
(914) 608-5063

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X Primary
Emergency Medicine Physician 207P00000X
Internal Medicine Physician 207R00000X
Nuclear Medicine Physician 207U00000X
Obstetrics & Gynecology Physician 207V00000X
Ophthalmology Physician 207W00000X
Orthopaedic Surgery Physician 207X00000X
Otolaryngology Physician 207Y00000X
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
Pediatrics Physician 208000000X
Physical Medicine & Rehabilitation Physician 208100000X
Psychiatry Physician 2084P0800X
Diagnostic Radiology Physician 2085R0202X
Surgery Physician 208600000X
Urology Physician 208800000X

Addresses

Primary practice location

111 E 210TH St
Bronx, NY 10467-2401

Mailing address

100 Corporate Dr
MMC-Cmo
Yonkers, NY 10701-6807
Phone (917) 378-6021

Other names 1

  • MMC-Faculty Practice Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ, FL, LA, CA6 enrollments
Opioid treatment program
Medicare-enrolled since May 12, 2021

Enrollment records 6

Enrollment IDStateProvider typePAC IDDetails
O20031113000235 NY Part B Supplier - Clinic/Group Practice 3779496021 Receives reassigned benefits from 6,078 practitioners
4 other NPIs on this enrollment
O20080125000165 NJ Part B Supplier - Clinic/Group Practice 3779496021 Receives reassigned benefits from 21 practitioners
Practice locations: Mahwah, NJ
O20200605001712 NY Part B Supplier - Opioid Treatment Program (Otp) 3779496021 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bronx, NY
O20250128001782 FL Part B Supplier - Clinic/Group Practice 3779496021 Receives reassigned benefits from 2 practitioners
Practice locations: Ponte Vedra Beach, FL; Fort Lauderdale, FL
O20250325001923 LA Part B Supplier - Clinic/Group Practice 3779496021 Receives reassigned benefits from 1 practitioner
Practice locations: Covington, LA
O20250606000493 CA Part B Supplier - Clinic/Group Practice 3779496021 Receives reassigned benefits from 1 practitioner
Practice locations: La Crescenta, CA; West Hollywood, CA

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 16

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
MMC Rehab Medicine

Locations (25 of 232)

1290 Summer St
Ste 2500
Stamford, CT 06905

555 Taxter Rd
Boston, MA 02241

31-00 Broadway
Ste 2
Fair Lawn, NJ 07410
Phone (201) 796-2255

1944 Corlies Ave
Ste 101
Neptune, NJ 07753
Phone (732) 775-8444

33 Newton Sparta Rd
Newton, NJ 07860
Phone (973) 383-2971

74 Oak St
Ste 2
Ridgewood, NJ 07450

33 Clyde Rd
Ste 102
Somerset, NJ 08873
Phone (732) 873-9200

540 Bordentown Ave
Ste 10B
South Amboy, NJ 08879
Phone (732) 553-1600

327 Route 59
Ste 117
Airmont, NY 10952

70 Dubois St
Albany, NY 12250

6 Henry St
Beacon, NY 12508
Phone (845) 831-0400

434 Old Post Rd
Bedford, NY 10506
Phone (914) 234-4445

1000 Teller Ave
Stop 145
Bronx, NY 10456

1010 Rev James a Polite Ave
Bronx, NY 10459

1110 Boston Rd
Bronx, NY 10456
Phone (718) 860-2515

1140 Webster Ave
Bronx, NY 10456

1180 Morris Park Ave
Ste 2
Bronx, NY 10461
Phone (347) 498-2462

1180 Tinton Ave
Bronx, NY 10456
Phone (718) 842-8133

1181 Grand Concourse
Bronx, NY 10452
Phone (718) 655-1400

1200 Waters Pl
Ste 117
Bronx, NY 10461

1200 Waters Pl
Ste M103
Bronx, NY 10461
Phone (718) 794-1549

124 W Fordham Rd
Bronx, NY 10468
Phone (718) 367-8500

1250 Waters Pl
Fl 10
Bronx, NY 10461
Phone (718) 515-2415

1250 Waters Pl
Fl 11
Bronx, NY 10461
Phone (347) 577-4410

1250 Waters Pl
Ste 501
Bronx, NY 10461
Phone (718) 409-9444

Practitioners & affiliated clinicians

Practitioners 7,216

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 7,216

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742256000000",
    "number": "1063525152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CORPORATE DR",
            "address_2": "MMC-CMO",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107016807",
            "telephone_number": "917-378-6021",
            "fax_number": "914-709-0386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 210TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672401",
            "telephone_number": "914-378-6021",
            "fax_number": "914-709-0386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTEFIORE MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MONTEFIORE MEDICAL CENTER",
        "enumeration_date": "2006-08-16",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A",
        "authorized_official_last_name": "PREOLO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SR DIRECTOR PROVIDER CREDENTIALING",
        "authorized_official_telephone_number": "914-608-5063"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd SteB,",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "MMC-Faculty Practice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.