Provider Demographics
NPI:1790799914
Name:MONTAG, RICHARD M (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:MONTAG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6 MUNSON CT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1633
Mailing Address - Country:US
Mailing Address - Phone:516-236-3002
Mailing Address - Fax:631-824-6476
Practice Address - Street 1:6 MUNSON CT
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-1633
Practice Address - Country:US
Practice Address - Phone:516-236-3002
Practice Address - Fax:631-824-6476
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002288213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT50724Medicare UPIN
NYP25621Medicare ID - Type Unspecified