Provider Demographics
NPI:1346458882
Name:MONTANARO, JOSEPH SAMUEL
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SAMUEL
Last Name:MONTANARO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 LESLIE AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5920
Mailing Address - Country:US
Mailing Address - Phone:315-732-9160
Mailing Address - Fax:
Practice Address - Street 1:ROUTES5&5A SANGERTOWN SQUARE
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413
Practice Address - Country:US
Practice Address - Phone:315-797-3357
Practice Address - Fax:315-797-1134
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008332-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician