Healthcare Provider Details

I. General information

NPI: 1538877931
Provider Name (Legal Business Name): DIANA MONTOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 HAMBURG TPKE STE 100
WAYNE NJ
07470-5243
US

IV. Provider business mailing address

629 CRANBURY RD FL 2
EAST BRUNSWICK NJ
08816-4096
US

V. Phone/Fax

Practice location:
  • Phone: 973-616-8400
  • Fax:
Mailing address:
  • Phone: 732-390-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01415500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ01415500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: