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General NPI Number Information
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NPI Number | 1174886915
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Entity Type | Individual
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Provider Name | MRS. MADELYN MONTANEZ
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Gender | Female
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 06/18/2012
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Provider Practice Location Address
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Address Line | 222 N TERRY HILL ROAD
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City | CARMEL
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State | NY
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Zip | 10512
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Country | US
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Telephone | 646-284-8041
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Fax | 845-225-5172
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Provider Business Mailing Address
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Address Line | 222 N TERRY HILL RD
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City | CARMEL
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State | NY
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Zip | 10512-5222
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Country | US
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Telephone | 646-284-8045
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Fax | 845-225-5172
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 826295
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License Number State | NY
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