Healthcare Provider Details

I. General information

NPI: 1255446399
Provider Name (Legal Business Name): STEPHEN HOWARD MONTALDI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N 16TH ST
NEW CASTLE IN
47362-4319
US

IV. Provider business mailing address

PO BOX 530 1007 N 16TH ST
NEW CASTLE IN
47362-4319
US

V. Phone/Fax

Practice location:
  • Phone: 765-529-0780
  • Fax: 765-529-3554
Mailing address:
  • Phone: 765-529-0780
  • Fax: 765-529-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberOS7171
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number002003452
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: