Provider Demographics
NPI:1003138306
Name:MONTEFORTE, ANTHONY
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:MONTEFORTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 ROUTE 112
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3236
Mailing Address - Country:US
Mailing Address - Phone:631-474-2657
Mailing Address - Fax:
Practice Address - Street 1:1110 ROUTE 112
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3236
Practice Address - Country:US
Practice Address - Phone:631-474-2657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-28
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist