Provider Demographics
NPI:1669863254
Name:MONTEGO MEDICAL CONSULTING, PC
Entity Type:Organization
Organization Name:MONTEGO MEDICAL CONSULTING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. CLINICAL & RESEARCH SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:J
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-252-3377
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10156-0121
Mailing Address - Country:US
Mailing Address - Phone:212-252-3377
Mailing Address - Fax:212-591-6032
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:212-252-3377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016058103G00000X
NY009091-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty