Healthcare Provider Details

I. General information

NPI: 1831801489
Provider Name (Legal Business Name): PETER D. MONTAN FNP-BC, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 GRAND CONCOURSE
BRONX NY
10468-1442
US

IV. Provider business mailing address

3131 GRAND CONCOURSE
BRONX NY
10468-1442
US

V. Phone/Fax

Practice location:
  • Phone: 917-728-9528
  • Fax:
Mailing address:
  • Phone: 917-728-9528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberF355546-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: