Provider Demographics
NPI:1174835300
Name:JOSEPH W. MONTAGNINO, MDPA
Entity Type:Organization
Organization Name:JOSEPH W. MONTAGNINO, MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MONTAGNINO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:973-238-0055
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-0098
Mailing Address - Country:US
Mailing Address - Phone:973-238-0055
Mailing Address - Fax:973-238-9826
Practice Address - Street 1:625 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-3401
Practice Address - Country:US
Practice Address - Phone:973-238-0055
Practice Address - Fax:973-238-9826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03358100261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3063402Medicaid
NJC56271Medicare UPIN
NJ3063402Medicaid