Provider Demographics
NPI:1811005135
Name:MONTGOMERY, KARYN M (MD)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:M
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 JACK MARTIN BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7778
Mailing Address - Country:US
Mailing Address - Phone:732-458-8000
Mailing Address - Fax:
Practice Address - Street 1:495 JACK MARTIN BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7778
Practice Address - Country:US
Practice Address - Phone:732-458-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81692207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ120493Medicare PIN