Healthcare Provider Details

I. General information

NPI: 1790095339
Provider Name (Legal Business Name): CHRISTOPHER JOSEPH MONTANARO RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 07/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVENUE, BOX MED
ROCHESTER NY
14642
US

IV. Provider business mailing address

78 QUAIL LANE
ROCHESTER NY
14624
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-0810
  • Fax:
Mailing address:
  • Phone: 585-469-7482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number014329
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number14329
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: