Healthcare Provider Details

I. General information

NPI: 1780761528
Provider Name (Legal Business Name): VIRGILIO A MONTELEONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 N BREWSTER RD
BREWSTER NY
10509-2844
US

IV. Provider business mailing address

PO BOX 413
BREWSTER NY
10509-0413
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-5161
  • Fax: 845-279-5070
Mailing address:
  • Phone: 845-279-5161
  • Fax: 845-279-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number110381
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: