Provider Demographics
NPI:1306990478
Name:MONTEFIORE MEDICAL PARK
Entity type:Organization
Organization Name:MONTEFIORE MEDICAL PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:AFSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMIN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:646-238-4864
Mailing Address - Street 1:2266 GLEASON AVE APT 6A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1625 POPLAR ST
Practice Address - Street 2:RADIOLOGY SUITE#100
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2653
Practice Address - Country:US
Practice Address - Phone:718-405-8440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011243-1261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile