Provider Demographics
NPI:1164255303
Name:MONFORT, CAMRYN
Entity type:Individual
Prefix:
First Name:CAMRYN
Middle Name:
Last Name:MONFORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NORTHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HALESITE
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1339
Mailing Address - Country:US
Mailing Address - Phone:516-398-6270
Mailing Address - Fax:
Practice Address - Street 1:497 CARROLL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1011
Practice Address - Country:US
Practice Address - Phone:718-636-0545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist