Provider Demographics
NPI:1609923325
Name:MONTECUOLLO, JEAN (DC)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:MONTECUOLLO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N BEVERWYCK RD
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2231
Mailing Address - Country:US
Mailing Address - Phone:973-334-5020
Mailing Address - Fax:973-334-0629
Practice Address - Street 1:145 N BEVERWYCK RD
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2231
Practice Address - Country:US
Practice Address - Phone:973-334-5020
Practice Address - Fax:973-334-0629
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00158600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMO 173426Medicare ID - Type Unspecified