Provider Demographics
NPI:1063641140
Name:MONTFORT, MARJORIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:
Last Name:MONTFORT
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 MAIDEN LN FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4812
Mailing Address - Country:US
Mailing Address - Phone:212-780-4459
Mailing Address - Fax:212-420-7211
Practice Address - Street 1:83 MAIDEN LN FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4812
Practice Address - Country:US
Practice Address - Phone:212-780-4459
Practice Address - Fax:212-420-7211
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY527844163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse