Provider Demographics
NPI:1679608046
Name:MONTAQUE, ROBERT (COTA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:MONTAQUE
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 PARK PLACE
Mailing Address - Street 2:5E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213
Mailing Address - Country:US
Mailing Address - Phone:347-262-2088
Mailing Address - Fax:
Practice Address - Street 1:959 PARK PL
Practice Address - Street 2:5E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1853
Practice Address - Country:US
Practice Address - Phone:347-262-2088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03359224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant