Provider Demographics
NPI:1265520258
Name:M. JOSEPH MONTI, INC.
Entity type:Organization
Organization Name:M. JOSEPH MONTI, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MONTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-488-1641
Mailing Address - Street 1:5700 W GENESEE ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-3200
Mailing Address - Country:US
Mailing Address - Phone:315-488-1641
Mailing Address - Fax:315-488-1655
Practice Address - Street 1:5700 W GENESEE ST
Practice Address - Street 2:SUITE 118
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-3200
Practice Address - Country:US
Practice Address - Phone:315-488-1641
Practice Address - Fax:315-488-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherBLUE CROSS BLUE SHIELD