Healthcare Provider Details

I. General information

NPI: 1114958345
Provider Name (Legal Business Name): PAUL MONTENEGRO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CLEMENTS BRIDGE ROAD
BARRINGTON NJ
08007-1814
US

IV. Provider business mailing address

600 CLEMENTS BRIDGE ROAD
BARRINGTON NJ
08007-1814
US

V. Phone/Fax

Practice location:
  • Phone: 856-547-8000
  • Fax: 856-547-8020
Mailing address:
  • Phone: 856-547-8000
  • Fax: 856-547-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00011400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: