Provider Demographics
NPI:1700940954
Name:PELLMAR, MONTE B (MD)
Entity Type:Individual
Prefix:DR
First Name:MONTE
Middle Name:B
Last Name:PELLMAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2 PARAGON WAY SUITE 400
Mailing Address - Street 2:MONMOUNT EXECUTIVE CENTER
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-431-4323
Mailing Address - Fax:732-431-4435
Practice Address - Street 1:2 PARAGON WAY SUITE 400
Practice Address - Street 2:MONMOUNT EXECUTIVE CENTER
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-431-4323
Practice Address - Fax:732-431-4435
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25 MA031393002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
087583Medicare ID - Type Unspecified
C61173Medicare UPIN