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General NPI Number Information
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NPI Number | 1174835300
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Entity Type | Organization
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Legal Business Name | JOSEPH W. MONTAGNINO, MDPA
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Dates
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Enumeration Date | 07/02/2010
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Last Update Date | 07/02/2010
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Provider Practice Location Address
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Address Line | 625 LAFAYETTE AVE
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City | HAWTHORNE
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State | NJ
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Zip | 07506-3401
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Country | US
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Telephone | 973-238-0055
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Fax | 973-238-9826
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Provider Business Mailing Address
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Address Line | PO BOX 98
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City | WYCKOFF
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State | NJ
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Zip | 07481-0098
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Country | US
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Telephone | 973-238-0055
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Fax | 973-238-9826
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LILIA B MONTAGNINO
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Credential | R.N.
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Telephone | 973-238-0055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 25MA03358100
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License Number State | NJ
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