Provider Demographics
NPI:1376899468
Name:MONTE, JO-ANN
Entity Type:Individual
Prefix:MS
First Name:JO-ANN
Middle Name:
Last Name:MONTE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JO-ANN
Other - Middle Name:
Other - Last Name:MONTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSED
Mailing Address - Street 1:126 MAIN ST
Mailing Address - Street 2:#153
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-5019
Mailing Address - Country:US
Mailing Address - Phone:516-506-9103
Mailing Address - Fax:
Practice Address - Street 1:126 MAIN ST
Practice Address - Street 2:#153
Practice Address - City:COLD SPRING HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11724-5019
Practice Address - Country:US
Practice Address - Phone:516-506-9103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY174400000XMedicaid