Provider Demographics
NPI:1679350011
Name:MONTENEGRO, JOSEPH (CRNP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MONTENEGRO
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MARTIN GROSS DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1616
Mailing Address - Country:US
Mailing Address - Phone:215-750-4285
Mailing Address - Fax:
Practice Address - Street 1:40 MARTIN GROSS DR
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1616
Practice Address - Country:US
Practice Address - Phone:215-750-4285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP031689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily