Provider Demographics
NPI:1558017350
Name:MONTO, IRENE MARY
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:MARY
Last Name:MONTO
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 1:4746 NEW HOPE N
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-2542
Mailing Address - Country:US
Mailing Address - Phone:315-741-0581
Mailing Address - Fax:
Practice Address - Street 1:4746 NEW HOPE N
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-2542
Practice Address - Country:US
Practice Address - Phone:315-741-0581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist