Provider Demographics
NPI:1821581869
Name:MONTGOMERY, JAMES R IV (RD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:MONTGOMERY
Suffix:IV
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SPRINGWOOD AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-6796
Mailing Address - Country:US
Mailing Address - Phone:732-539-3584
Mailing Address - Fax:
Practice Address - Street 1:1201 SPRINGWOOD AVE
Practice Address - Street 2:
Practice Address - City:ASBURY PARK
Practice Address - State:NJ
Practice Address - Zip Code:07712-6752
Practice Address - Country:US
Practice Address - Phone:267-229-9535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1105168133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered