Provider Demographics
NPI:1477817989
Name:MONTAGNA, KAREN JULIA (TSHH, MLS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JULIA
Last Name:MONTAGNA
Suffix:
Gender:F
Credentials:TSHH, MLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 MARIA DR
Mailing Address - Street 2:
Mailing Address - City:HOLMES
Mailing Address - State:NY
Mailing Address - Zip Code:12531-5456
Mailing Address - Country:US
Mailing Address - Phone:845-855-5498
Mailing Address - Fax:
Practice Address - Street 1:28 MARIA DR
Practice Address - Street 2:
Practice Address - City:HOLMES
Practice Address - State:NY
Practice Address - Zip Code:12531-5456
Practice Address - Country:US
Practice Address - Phone:845-855-5498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X, 225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist