Healthcare Provider Details

I. General information

NPI: 1164658985
Provider Name (Legal Business Name): MELBA LISSETTE MONTES N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9413 FLATLANDS AVE
BROOKLYN NY
11236
US

IV. Provider business mailing address

550 1ST AVE # 15SOUTH5
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 718-257-6615
  • Fax: 718-272-3365
Mailing address:
  • Phone: 212-562-3917
  • Fax: 212-263-8640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number340716
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number340716
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: