Healthcare Provider Details

I. General information

NPI: 1942752209
Provider Name (Legal Business Name): JADE MONTECILLO VULLO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JADE R. MONTECILLO NP

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL
NEW YORK NY
10029-6504
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6500
  • Fax:
Mailing address:
  • Phone: 212-241-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: