Healthcare Provider Details

I. General information

NPI: 1508429408
Provider Name (Legal Business Name): MICHAEL BENJAMIN MONTALBARON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S STE 510
BRONX NY
10461-1197
US

IV. Provider business mailing address

1400 PELHAM PKWY S STE 510
BRONX NY
10461-1197
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-6562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number337591
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA194377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: