Healthcare Provider Details

I. General information

NPI: 1073477527
Provider Name (Legal Business Name): NAOMI MONTEROLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 E 148TH ST
BRONX NY
10455-4005
US

IV. Provider business mailing address

1419 JESUP AVE APT 5A
BRONX NY
10452-1993
US

V. Phone/Fax

Practice location:
  • Phone: 718-292-4640
  • Fax: 718-402-5006
Mailing address:
  • Phone: 646-546-4633
  • Fax: 718-402-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: