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NPI Code Detail

MEDICARE: CAROLYN MONTAQUE C.R.N.A

MEDICARE: CAROLYN MONTAQUE C.R.N.A
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
1367500000XCertified Registered Nurse Anesthetist501480NY

General Provider Information

NPI Number : 1336146539
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN MONTAQUE C.R.N.A
Provider Business Mailing Address
First Line : 5645 MAIN ST
Second Line :
City : FLUSHING
State : NY
Zip : 11355-5045
Country : US
Telephone Number : 917-650-1275
Fax Number :
Provider Business Practice Location Address
First Line : 5645 MAIN ST
Second Line :
City : FLUSHING
State : NY
Zip : 11355-5045
Country : US
Telephone Number : 917-650-1275
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2005
Last Update Date : 10/09/2024

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