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NPI Code Detail

MEDICARE: MRS. MARY JO MONTIJO SLP-CCC, MS, TSHH

MEDICARE: MRS. MARY JO MONTIJO SLP-CCC, MS, TSHH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist016636-1NY

General Provider Information

NPI Number : 1205089760
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY JO MONTIJO SLP-CCC, MS, TSHH
Provider Business Mailing Address
First Line : 7214 FORT HAMILTON PKWY
Second Line : 3B
City : BROOKLYN
State : NY
Zip : 11228-1906
Country : US
Telephone Number : 347-394-4510
Fax Number : 347-394-2510
Provider Business Practice Location Address
First Line : 7214 FORT HAMILTON PKWY
Second Line : 3B
City : BROOKLYN
State : NY
Zip : 11228-1906
Country : US
Telephone Number : 347-394-4510
Fax Number : 347-394-4510
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2008
Last Update Date : 10/28/2008

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