Provider Demographics
NPI:1770851255
Name:MONTALTO, CAROL J
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:J
Last Name:MONTALTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 NAUTILUS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1829
Mailing Address - Country:US
Mailing Address - Phone:631-754-2917
Mailing Address - Fax:
Practice Address - Street 1:40 FROST MILL RD
Practice Address - Street 2:
Practice Address - City:MILL NECK
Practice Address - State:NY
Practice Address - Zip Code:11765-1102
Practice Address - Country:US
Practice Address - Phone:516-922-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY93480956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist