Healthcare Provider Details

I. General information

NPI: 1669863254
Provider Name (Legal Business Name): MONTEGO MEDICAL CONSULTING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 W 34TH ST
NEW YORK NY
10001-3006
US

IV. Provider business mailing address

PO BOX 121
NEW YORK NY
10156-0121
US

V. Phone/Fax

Practice location:
  • Phone: 212-252-3377
  • Fax:
Mailing address:
  • Phone: 212-252-3377
  • Fax: 212-591-6032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number016058
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number009091-1
License Number StateNY

VIII. Authorized Official

Name: DR. CARLTON J. ADAMS
Title or Position: DIR. CLINICAL & RESEARCH SERVICES
Credential: PHD
Phone: 212-252-3377