Provider Demographics
NPI:1871690107
Name:MONTALBANO, KOREN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KOREN
Middle Name:
Last Name:MONTALBANO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 CUPSAW AVE
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-2947
Mailing Address - Country:US
Mailing Address - Phone:201-818-1114
Mailing Address - Fax:
Practice Address - Street 1:407 CEDAR LN
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1708
Practice Address - Country:US
Practice Address - Phone:201-894-9900
Practice Address - Fax:201-894-9951
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA0920000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist