Provider Demographics
NPI:1396917100
Name:ELGARTEN, MONTE LANE (MD)
Entity type:Individual
Prefix:DR
First Name:MONTE
Middle Name:LANE
Last Name:ELGARTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 HORIZON FARMS DR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-2260
Mailing Address - Country:US
Mailing Address - Phone:845-790-3371
Mailing Address - Fax:845-790-1109
Practice Address - Street 1:859 MCCULLOUGH AVE APT 514
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-7256
Practice Address - Country:US
Practice Address - Phone:845-258-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156066208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF42538Medicare UPIN