Provider Demographics
NPI:1659440683
Name:MONTEBELLO, KAREN (RPAC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MONTEBELLO
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:986 SUNRISE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703
Mailing Address - Country:US
Mailing Address - Phone:631-587-6060
Mailing Address - Fax:631-587-1364
Practice Address - Street 1:986 SUNRISE HIGHWAY
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703
Practice Address - Country:US
Practice Address - Phone:631-587-6060
Practice Address - Fax:631-587-1364
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007073363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP03230Medicare UPIN
NY0F6411Medicare ID - Type Unspecified