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General NPI Number Information
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NPI Number | 1881150688
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Entity Type | Individual
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Provider Name | NICHOLAS JOHN MONTANARO DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 02/17/2019
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 207 HALLOCK RD STE 2
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City | STONY BROOK
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State | NY
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Zip | 11790-3072
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Country | US
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Telephone | 631-675-9601
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Fax | 631-675-9602
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Provider Business Mailing Address
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Address Line | 207 HALLOCK RD STE 2
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City | STONY BROOK
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State | NY
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Zip | 11790-3072
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Country | US
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Telephone | 631-675-9601
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Fax | 631-675-9602
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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 | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 338189
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License Number State | NY
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