Montefiore Medical Center
Organization Active NPI Anesthesiology Physician · Bronx, NY
NPI 1063525152 · NPPES record last updated Mar 18, 2025
Key facts
- NPI
- 1063525152
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anesthesiology Physician 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
- Organization subpart
- Yes
- Parent organization (as reported)
- MONTEFIORE MEDICAL CENTER
Authorized official
- Name
- John M Preolo
- Title
- Sr Director Provider Credentialing
- Phone
- (914) 608-5063
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 16
Practitioners 7,233
-
Carolyn Abedor, P.T.
-
Arthur Abelow, MD
-
Aryeh Abelow, MD
-
Edna Ohemaa Aboagye, FNP-BC
-
Jerryl P Abraham, MD
-
Nitya Abraham, M.D.
-
Matthew K. Abramowitz, M.D.
-
Steven B Abrams, MD
-
Sandra M Acevedo, CRNA
-
Janine Adamczyk, MD
-
Casilda Adames, NP, RN
-
Prakhar Agarwal, M.D.
-
Francis O. Agbonkpolo, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (6 enrollments) in NY, NJ, FL, LA, CA
- Opioid treatment program
- Medicare-enrolled since May 12, 2021
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- Peter Marcus
Locations (25 of 221)
1 Hospital Plz
Stamford, CT 06902
Phone (203) 276-4925
1290 Summer St
Ste 2500
Stamford, CT 06905
157 N Seymour Ave
Mundelein, IL 60060
Phone (847) 566-0300
555 Taxter Rd
Boston, MA 02241
5 Progress St
#2
Edison, NJ 08820
Phone (908) 755-9671
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
5678 Berkshire Valley Rd
Oak Ridge, NJ 07438
Phone (973) 697-0200
74 Oak St
Ridgewood, NJ 07450
Phone (201) 345-3688
74 Oak St
Ste 2
Ridgewood, NJ 07450
327 Route 59
Ste 117
Airmont, NY 10952
327 Route 59
Ste 1
Airmont, NY 10952
Phone (845) 738-7351
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
305 E 161st St
#1
Bronx, NY 10451
1600 Webster Ave
Bronx, NY 10457
Phone (718) 295-5180
2252 Crotona Ave
Bronx, NY 10457
1425 Walton Ave
Bronx, NY 10452
Phone (718) 293-5970
456 White Plains Rd
Stop 174
Bronx, NY 10473
613 E 233rd St
Bronx, NY 10466
1180 Morris Park Ave
Ste 2
Bronx, NY 10461
Phone (347) 498-2462
1625 Eastchester Rd
Bronx, NY 10461
Phone (718) 904-4032
1250 Waters Pl
Bldg 2
Bronx, NY 10461
Phone (718) 920-4531
1980 Lafayette Ave
Rm 273
Bronx, NY 10473
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician |
207L00000X | Yes | ||
| 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
- MMC-Faculty Practice
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Other providers in Bronx, NY
- Montefiore Medical Center
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- Montefiore Medical Center
- Montefiore Medical Center
- Montefiore Medical Center
- Montefiore Medical Center
- Montefiore Medical Center
- Montefiore Medical Center
All providers in Bronx, NY · Anesthesiology Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.