Healthcare Provider Details

I. General information

NPI: 1114914348
Provider Name (Legal Business Name): JENNIFER ROSE MONTANTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21000 NE 28TH AVE SUITE 205
AVENTURA FL
33180-1421
US

IV. Provider business mailing address

PO BOX 160010
HIALEAH FL
33016-0001
US

V. Phone/Fax

Practice location:
  • Phone: 305-933-5993
  • Fax: 305-933-9415
Mailing address:
  • Phone: 305-933-5993
  • Fax: 305-933-9415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME90145
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME90145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: