Provider Demographics
NPI:1376995993
Name:MONTEVERDE, BETH JENNIFER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:JENNIFER
Last Name:MONTEVERDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:JENNIFER
Other - Last Name:VOGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:600 NOTHERN BOULEVARD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-387-3990
Mailing Address - Fax:
Practice Address - Street 1:600 NORTHERN BLVD STE 111
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5200
Practice Address - Country:US
Practice Address - Phone:516-387-3990
Practice Address - Fax:516-387-3930
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019819363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant