Provider Demographics
NPI:1811381155
Name:MONTANEZ, ANGEL LEONEL (MS, ATC, PES)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:LEONEL
Last Name:MONTANEZ
Suffix:
Gender:M
Credentials:MS, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1017
Mailing Address - Country:US
Mailing Address - Phone:201-658-8328
Mailing Address - Fax:
Practice Address - Street 1:2641 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5943
Practice Address - Country:US
Practice Address - Phone:201-761-7326
Practice Address - Fax:201-761-7314
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001473002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer