Healthcare Provider Details

I. General information

NPI: 1639650989
Provider Name (Legal Business Name): MS. MELANIE KRYSTAL MONTALVO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2026
Certification Date:
Deactivation Date: 08/18/2023
Reactivation Date: 08/24/2026

III. Provider practice location address

98 E 4TH ST
NEW YORK NY
10003-9001
US

IV. Provider business mailing address

76A WOLKOFF LN
STATEN ISLAND NY
10303-1883
US

V. Phone/Fax

Practice location:
  • Phone: 646-230-8190
  • Fax:
Mailing address:
  • Phone: 718-514-4143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: