Healthcare Provider Details

I. General information

NPI: 1083847461
Provider Name (Legal Business Name): MARY MONTEMURRO RNC,NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W 12TH ST 616
NEW YORK NY
10011-7762
US

IV. Provider business mailing address

82 W 12TH ST
NEW YORK NY
10011-8667
US

V. Phone/Fax

Practice location:
  • Phone: 212-604-8256
  • Fax:
Mailing address:
  • Phone: 212-604-8256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number310003-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: