Provider Demographics
NPI:1548740004
Name:LAMONTAGNE, MADIA
Entity Type:Individual
Prefix:
First Name:MADIA
Middle Name:
Last Name:LAMONTAGNE
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 1:2716 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1750
Mailing Address - Country:US
Mailing Address - Phone:917-715-8377
Mailing Address - Fax:
Practice Address - Street 1:2716 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1750
Practice Address - Country:US
Practice Address - Phone:917-715-8377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist