Provider Demographics
NPI:1902436215
Name:MONTGOMERY, ROSELYN J (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ROSELYN
Middle Name:J
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8606
Mailing Address - Country:US
Mailing Address - Phone:917-751-7495
Mailing Address - Fax:
Practice Address - Street 1:3044 MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8606
Practice Address - Country:US
Practice Address - Phone:917-751-7495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-25
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY731530-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse