MEDICARE: EDWARD MONTOYA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP1100X	Podiatric Clinic/Center

General Provider Information

NPI Number	:	1083067771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD MONTOYA

Provider Business Mailing Address
First Line	:	300 WASHINGTON AVE
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07202-3317
Country	:	US
Telephone Number	:	908-820-9799
Fax Number	:	908-264-0772

Provider Business Practice Location Address
First Line	:	300 WASHINGTON AVE
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07202-3317
Country	:	US
Telephone Number	:	908-820-9799
Fax Number	:	908-264-0772

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDWARD MONTOYA
Credential	:	DPM
Telephone Number	:	908-820-9799

Provider Enumeration Date	:	07/18/2016
Last Update Date	:	07/18/2016

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Directions to “EDWARD MONTOYA ” Practice Location

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