Provider Demographics
NPI:1477314508
Name:MONTES, KISHANDA LARRETTE
Entity Type:Individual
Prefix:
First Name:KISHANDA
Middle Name:LARRETTE
Last Name:MONTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 LIBERTY AVENUE
Mailing Address - Street 2:PO BOX 5823
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205
Mailing Address - Country:US
Mailing Address - Phone:908-378-5357
Mailing Address - Fax:
Practice Address - Street 1:292 OREGON ST
Practice Address - Street 2:
Practice Address - City:VAUXHALL
Practice Address - State:NJ
Practice Address - Zip Code:07088-1319
Practice Address - Country:US
Practice Address - Phone:908-378-5357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No347C00000XTransportation ServicesPrivate Vehicle