Healthcare Provider Details

I. General information

NPI: 1568864270
Provider Name (Legal Business Name): MARIA MONTALVO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 RIVER RD STE 103
EDGEWATER NJ
07020-1002
US

IV. Provider business mailing address

125 RIVER RD STE 103
EDGEWATER NJ
07020-1002
US

V. Phone/Fax

Practice location:
  • Phone: 201-969-2111
  • Fax: 201-969-8015
Mailing address:
  • Phone: 201-969-2111
  • Fax: 201-969-8015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00513400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ00513400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: