Provider Demographics
NPI:1083708085
Name:MONTOYA, JANNETH (MD)
Entity Type:Individual
Prefix:
First Name:JANNETH
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 E GRASSY SPRAIN RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-4620
Mailing Address - Country:US
Mailing Address - Phone:914-346-8999
Mailing Address - Fax:914-346-8998
Practice Address - Street 1:35 E GRASSY SPRAIN RD
Practice Address - Street 2:SUITE 405
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-4620
Practice Address - Country:US
Practice Address - Phone:914-346-8999
Practice Address - Fax:914-346-8998
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216114207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00665274Medicaid
NYA400030473Medicare PIN
NYH18436Medicare UPIN