Healthcare Provider Details

I. General information

NPI: 1427481738
Provider Name (Legal Business Name): MARY ELIZABETH MONTGOMERY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY MONTGOMERY

II. Dates (important events)

Enumeration Date: 08/11/2013
Last Update Date: 02/09/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 BROADWAY FL 7
NEW YORK NY
10001-3701
US

IV. Provider business mailing address

1250 BROADWAY FL 7
NEW YORK NY
10001-3701
US

V. Phone/Fax

Practice location:
  • Phone: 212-690-1920
  • Fax: 212-290-3933
Mailing address:
  • Phone: 212-609-1920
  • Fax: 212-290-3933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP-02738
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: