Provider Demographics
NPI:1619189511
Name:MONTILUS, MARGALY (APN)
Entity type:Individual
Prefix:
First Name:MARGALY
Middle Name:
Last Name:MONTILUS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:MARGALY
Other - Middle Name:
Other - Last Name:MONTILUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:79 MOUNTAIN AVE
Mailing Address - Street 2:LLEWELLYN PARK
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4956
Mailing Address - Country:US
Mailing Address - Phone:973-736-7188
Mailing Address - Fax:
Practice Address - Street 1:150 BERGEN ST RM M219
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2496
Practice Address - Country:US
Practice Address - Phone:973-972-4282
Practice Address - Fax:972-972-1649
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00096900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health