Provider Demographics
NPI:1568864270
Name:MONTALVO, MARIA (NP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 RIVER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1002
Mailing Address - Country:US
Mailing Address - Phone:201-969-2111
Mailing Address - Fax:201-969-8015
Practice Address - Street 1:125 RIVER RD STE 103
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1002
Practice Address - Country:US
Practice Address - Phone:201-969-2111
Practice Address - Fax:201-969-8015
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00513400363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care