Provider Demographics
NPI:1679554596
Name:MONTALVAN, JORGE I (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:I
Last Name:MONTALVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3848 FAU BLVD
Mailing Address - Street 2:210
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6437
Mailing Address - Country:US
Mailing Address - Phone:561-394-3088
Mailing Address - Fax:561-394-3077
Practice Address - Street 1:3848 FAU BLVD
Practice Address - Street 2:SUITE # 210
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6437
Practice Address - Country:US
Practice Address - Phone:561-394-3088
Practice Address - Fax:561-394-3077
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA5033700207R00000X
FLME106556207R00000X
NY175179207R00000X
NC2010-00655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE86448Medicare UPIN
FLMC-EB7462Medicare UPIN
NJ635242Medicare PIN