Healthcare Provider Details

I. General information

NPI: 1053393140
Provider Name (Legal Business Name): PAULA CHRISTINE MONTAGNA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 E MAIN ST
RIVERHEAD NY
11901-1524
US

IV. Provider business mailing address

228 SUNSET AVE
WESTHAMPTON BEACH NY
11978-2049
US

V. Phone/Fax

Practice location:
  • Phone: 631-727-8827
  • Fax:
Mailing address:
  • Phone: 631-288-4994
  • Fax: 631-288-4994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number002371-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number002371-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number002371-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: