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General NPI Number Information
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NPI Number | 1023543972
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Entity Type | Organization
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Legal Business Name | MONTVILLE MEDICAL, LLC
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 115 HORSENECK RD SUITE 4
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City | MONTVILLE
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State | NJ
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Zip | 07045-9365
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Country | US
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Telephone | 732-709-3658
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Fax | 732-709-3659
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Provider Business Mailing Address
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Address Line | 115 HORSENECK RD SUITE 4
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City | MONTVILLE
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State | NJ
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Zip | 07045-9365
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DONNA GISELDA D'ALESSIO
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Credential | MD
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Telephone | 973-818-7980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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