Provider Demographics
NPI:1497081228
Name:MONTER, MICHAEL LAWRENCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:MONTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2050 STATE ROUTE 27
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1380
Mailing Address - Country:US
Mailing Address - Phone:732-232-7787
Mailing Address - Fax:
Practice Address - Street 1:8021 PHILIPS HWY STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7460
Practice Address - Country:US
Practice Address - Phone:904-323-0954
Practice Address - Fax:904-660-2125
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00300400213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL810687502OtherTAX ID
FLPO4347OtherMEDICAL LICENSE FL
NJ196965A7FMedicare PIN