MEDICARE: MARIA MONTALVO NP

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	363LA2100X	Acute Care Nurse Practitioner	26NJ00513400	NJ

General Provider Information

NPI Number	:	1568864270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA MONTALVO NP

Provider Business Mailing Address
First Line	:	125 RIVER RD STE 103
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1002
Country	:	US
Telephone Number	:	201-969-2111
Fax Number	:	201-969-8015

Provider Business Practice Location Address
First Line	:	125 RIVER RD STE 103
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1002
Country	:	US
Telephone Number	:	201-969-2111
Fax Number	:	201-969-8015

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

Provider Enumeration Date	:	09/24/2014
Last Update Date	:	01/23/2020

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Directions to “ MARIA MONTALVO NP” Practice Location

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