MEDICARE: DR. NORMA JEANETTE MONTIEL D.O.

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
1	207N00000X	Dermatology Physician	219386-1	NY

General Provider Information

NPI Number	:	1265461537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORMA JEANETTE MONTIEL D.O.

Provider Business Mailing Address
First Line	:	3 DELAWARE DR
Second Line	:	4 PROHEATH PLAZA
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1116
Country	:	US
Telephone Number	:	516-608-2830
Fax Number	:	516-622-6199

Provider Business Practice Location Address
First Line	:	3 DELAWARE DR
Second Line	:	4 PROHEATH PLAZA
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1116
Country	:	US
Telephone Number	:	516-608-2830
Fax Number	:	516-622-6199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	09/28/2009

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