Healthcare Provider Details

I. General information

NPI: 1699269670
Provider Name (Legal Business Name): PHILIP MONTANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 COURT ST
BROOKLYN NY
11231-4334
US

IV. Provider business mailing address

5402 FORT HAMILTON PKWY 6TH FLOOR
BROOKLYN NY
11219-4037
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-7400
  • Fax:
Mailing address:
  • Phone: 718-283-8773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number329052
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number291842
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA164985
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number329052
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number291842
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: