Healthcare Provider Details

I. General information

NPI: 1649253618
Provider Name (Legal Business Name): JOSEPH G MONTALTO MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SOUTH ST SUITE 110
OYSTER BAY NY
11771-2251
US

IV. Provider business mailing address

123 SOUTH ST SUITE 112
OYSTER BAY NY
11771-2251
US

V. Phone/Fax

Practice location:
  • Phone: 516-624-6739
  • Fax: 516-624-6829
Mailing address:
  • Phone: 516-624-6739
  • Fax: 516-624-6829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number005925
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0190711
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: