=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255446399
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN HOWARD MONTALDI D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 01/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1007 N 16TH ST
-----------------------------------------------------
City | NEW CASTLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47362-4319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-529-0780
-----------------------------------------------------
Fax | 765-529-3554
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 530 1007 N 16TH ST
-----------------------------------------------------
City | NEW CASTLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47362-4319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-529-0780
-----------------------------------------------------
Fax | 765-529-3554
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RS0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | OS7171
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RS0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 002003452
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------