Provider Demographics
NPI:1376945154
Name:MONTEMURRO OBGYN, LLC
Entity Type:Organization
Organization Name:MONTEMURRO OBGYN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONTEMURRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-341-3434
Mailing Address - Street 1:1027 POMPTON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1155
Mailing Address - Country:US
Mailing Address - Phone:973-341-3434
Mailing Address - Fax:973-341-3437
Practice Address - Street 1:1027 POMPTON AVE FL 2
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1155
Practice Address - Country:US
Practice Address - Phone:973-341-3434
Practice Address - Fax:973-341-3437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA05893500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6043208Medicaid
NJ758361Medicare PIN