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General NPI Number Information
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NPI Number | 1053566232
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Entity Type | Organization
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Legal Business Name | MONTICELLO FAMILY MEDICINE & WALK-IN CENTER
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 10 PRINCE ST STE 7
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City | MONTICELLO
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State | NY
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Zip | 12701-1919
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Country | US
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Telephone | 845-794-7943
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Fax | 845-791-8101
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Provider Business Mailing Address
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Address Line | 126 UPPER PINEKILL RD
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City | WESTBROOKVILLE
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State | NY
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Zip | 12785
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Country | US
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Telephone | 845-794-7943
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Fax | 845-791-8101
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. ROBIN A DECARO
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Credential |
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Telephone | 845-856-4936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 229335
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License Number State | NY
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