Provider Demographics
NPI:1679722110
Name:DR, RICHARD A. MONTI, DPM, PA
Entity type:Organization
Organization Name:DR, RICHARD A. MONTI, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONTI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-357-1555
Mailing Address - Street 1:714 BROADWAY
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514
Mailing Address - Country:US
Mailing Address - Phone:973-357-1555
Mailing Address - Fax:973-357-2640
Practice Address - Street 1:714 BROADWAY
Practice Address - Street 2:SUITE #1
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514
Practice Address - Country:US
Practice Address - Phone:973-357-1555
Practice Address - Fax:973-357-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01726213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1737309Medicaid
NJ454052Medicare UPIN
NJT45367Medicare PIN