Healthcare Provider Details

I. General information

NPI: 1326708280
Provider Name (Legal Business Name): STEPHANIE M MONTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 UNION PL STE 204
SUMMIT NJ
07901-2568
US

IV. Provider business mailing address

51 MOORE AVE
WALDWICK NJ
07463-1947
US

V. Phone/Fax

Practice location:
  • Phone: 908-273-5537
  • Fax:
Mailing address:
  • Phone: 201-694-7964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: