Provider Demographics
NPI:1164423653
Name:MONTALVO, LUIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7523 FORT HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2305
Mailing Address - Country:US
Mailing Address - Phone:718-745-7266
Mailing Address - Fax:718-491-2765
Practice Address - Street 1:7523 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2305
Practice Address - Country:US
Practice Address - Phone:718-745-7266
Practice Address - Fax:718-491-2765
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01284739Medicaid
NYP666499072Medicare PIN
NY01284739Medicaid
NY01HCRZMedicare PIN
NYU33368Medicare UPIN