1265590160 NPI number — DR. FRED MONTAS M.D.

Table of content: DR. FRED MONTAS M.D. (NPI 1265590160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265590160 NPI number — DR. FRED MONTAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTAS
Provider First Name:
FRED
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1265590160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
182 8TH AVE
Provider Second Line Business Mailing Address:
STREET LEVEL
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11215-2229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-768-6048
Provider Business Mailing Address Fax Number:
718-788-2812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
182 8TH AVE
Provider Second Line Business Practice Location Address:
STREET LEVEL
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11215-2229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-768-6048
Provider Business Practice Location Address Fax Number:
718-788-2812
Provider Enumeration Date:
12/04/2006

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: 207X00000X , with the licence number:  105863 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 128884 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 577760 . This is a "ATLANTIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0C0036 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 90411 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 218602 . This is a "WORKER COM. (W.C.)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4523376 . This is a "AETNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 90411 . This is a "U.S.HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: M6014P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0052442 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0313516002 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 105863-A16 . This is a "HEALTHFIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 70288884 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 56502 . This is a "BLUECROSS/BLUESHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2826645 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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