Provider Demographics
NPI:1023069168
Name:MONTES, MYRTHO (MD)
Entity type:Individual
Prefix:DR
First Name:MYRTHO
Middle Name:
Last Name:MONTES
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 1:213 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2917
Mailing Address - Country:US
Mailing Address - Phone:973-802-6380
Mailing Address - Fax:973-802-2276
Practice Address - Street 1:213 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2917
Practice Address - Country:US
Practice Address - Phone:973-802-6380
Practice Address - Fax:973-802-2276
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA073337207R00000X
NY144054207R00000X
PAMD424008207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01009907Medicaid
NY01009907Medicaid
NYE06950Medicare UPIN