Provider Demographics
NPI:1093700510
Name:MONTALBANO, CHRISTIN A (MD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIN
Middle Name:A
Last Name:MONTALBANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 ALEX CIR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4765
Mailing Address - Country:US
Mailing Address - Phone:917-693-0845
Mailing Address - Fax:
Practice Address - Street 1:2024 CRESTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4244
Practice Address - Country:US
Practice Address - Phone:718-618-0401
Practice Address - Fax:718-299-6797
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226622207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02499883Medicaid
NY111AT1Medicare ID - Type Unspecified
NYH79790Medicare UPIN