Provider Demographics
NPI:1548359334
Name:MONTI, RICHARD A (DPM)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:MONTI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 BROADWAY
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514
Mailing Address - Country:US
Mailing Address - Phone:973-357-1555
Mailing Address - Fax:
Practice Address - Street 1:714 BROADWAY
Practice Address - Street 2:SUITE #1
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514
Practice Address - Country:US
Practice Address - Phone:973-357-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01726213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1737309Medicaid
454052Medicare PIN
454052Medicare ID - Type Unspecified
NJ1737309Medicaid