Provider Demographics
NPI:1073149456
Name:J MONTELUS NURSE PRACTITIONER IN ADULT HEALTH PC
Entity Type:Organization
Organization Name:J MONTELUS NURSE PRACTITIONER IN ADULT HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTELUS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:516-661-6274
Mailing Address - Street 1:1674 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3427
Mailing Address - Country:US
Mailing Address - Phone:516-661-6274
Mailing Address - Fax:
Practice Address - Street 1:1674 BROOKLYN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3427
Practice Address - Country:US
Practice Address - Phone:516-661-6274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health