Provider Demographics
NPI:1023543972
Name:MONTVILLE MEDICAL, LLC
Entity Type:Organization
Organization Name:MONTVILLE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:GISELDA
Authorized Official - Last Name:D'ALESSIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-818-7980
Mailing Address - Street 1:115 HORSENECK RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9365
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 HORSENECK RD
Practice Address - Street 2:SUITE 4
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9365
Practice Address - Country:US
Practice Address - Phone:732-709-3658
Practice Address - Fax:732-709-3659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty