Provider Demographics
NPI:1184884629
Name:SERVON MONTALI, JESSICA A (RD)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:A
Last Name:SERVON MONTALI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:SERVON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:32 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-2310
Mailing Address - Country:US
Mailing Address - Phone:732-605-1943
Mailing Address - Fax:
Practice Address - Street 1:75 VERONICA AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5002
Practice Address - Country:US
Practice Address - Phone:732-570-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ919241133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered