Provider Demographics
NPI:1518558196
Name:GRUNTE, MONTA
Entity Type:Individual
Prefix:
First Name:MONTA
Middle Name:
Last Name:GRUNTE
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 1:1075 SHEEPSHEAD BAY RD APT 3L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4261
Mailing Address - Country:US
Mailing Address - Phone:646-421-9621
Mailing Address - Fax:
Practice Address - Street 1:1075 SHEEPSHEAD BAY RD APT 3L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4261
Practice Address - Country:US
Practice Address - Phone:646-421-9621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1454392201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1454392201OtherNY STATE DOE