MEDICARE: SYRETAH MONTGOMERY

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	164W00000X	Licensed Practical Nurse	297352-1	NY

General Provider Information

NPI Number	:	1598131724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYRETAH MONTGOMERY

Provider Business Mailing Address
First Line	:	1 EDUCATION DR
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-6719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 EDUCATION DR
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-6719
Country	:	US
Telephone Number	:	516-572-7000
Fax Number	:

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

Provider Enumeration Date	:	08/11/2015
Last Update Date	:	03/08/2016

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Directions to “ SYRETAH MONTGOMERY ” Practice Location

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