Provider Demographics
NPI:1538614797
Name:MONTALVO, MONICA JEAN (DPM)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:JEAN
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-4006
Mailing Address - Country:US
Mailing Address - Phone:914-378-7171
Mailing Address - Fax:914-378-7454
Practice Address - Street 1:107 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4006
Practice Address - Country:US
Practice Address - Phone:914-378-7171
Practice Address - Fax:914-378-7454
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY006820213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program