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General NPI Number Information
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NPI Number | 1396917100
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Entity Type | Individual
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Provider Name | MONTE LANE ELGARTEN MD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 859 MCCULLOUGH AVE APT 514
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City | ORLANDO
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State | FL
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Zip | 32803-7256
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Country | US
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Telephone | 845-258-8272
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Fax |
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Provider Business Mailing Address
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Address Line | 52 HORIZON FARMS DR
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City | WARWICK
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State | NY
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Zip | 10990-2260
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Country | US
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Telephone | 845-790-3371
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Fax | 845-790-1109
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 156066
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License Number State | NY
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