Provider Demographics
NPI:1801818059
Name:MONTAGUE, JANICE LYNN
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:LYNN
Last Name:MONTAGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 LAFAYETTE AVENUE
Mailing Address - Street 2:SUITE 290
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901
Mailing Address - Country:US
Mailing Address - Phone:845-369-3550
Mailing Address - Fax:845-369-3552
Practice Address - Street 1:257 LAFAYETTE AVENUE
Practice Address - Street 2:SUITE 290
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:845-369-3550
Practice Address - Fax:845-369-3552
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194024208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01600522046Medicaid