Provider Demographics
NPI:1407118250
Name:MONTORO, LUIS G (MSED)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:G
Last Name:MONTORO
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3563 80TH ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-4916
Mailing Address - Country:US
Mailing Address - Phone:917-734-4490
Mailing Address - Fax:718-803-3957
Practice Address - Street 1:3563 80TH ST APT 4B
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-4916
Practice Address - Country:US
Practice Address - Phone:917-734-4490
Practice Address - Fax:718-803-3957
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist