Provider Demographics
NPI:1801326624
Name:MONTOYA, ILEANA (RDN)
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1017
Mailing Address - Country:US
Mailing Address - Phone:908-590-3147
Mailing Address - Fax:
Practice Address - Street 1:1210 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1017
Practice Address - Country:US
Practice Address - Phone:908-590-3147
Practice Address - Fax:908-590-3147
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist