1144875253 NPI number — ERIC MONTOYE

Table of content: ERIC MONTOYE (NPI 1144875253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144875253 NPI number — ERIC MONTOYE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTOYE
Provider First Name:
ERIC
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144875253
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
475 ALLENDALE RD STE 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KING OF PRUSSIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19406-1495
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-270-0370
Provider Business Mailing Address Fax Number:
610-270-0374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
931 E HAVERFORD RD FL 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYN MAWR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19010-3838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-557-0590
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT027889 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: PT027889 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)