Basic Information
| Provider Information | |||||||||
| NPI: | 1376945154 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTEMURRO OBGYN, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1027 POMPTON AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | CEDAR GROVE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070091155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9733413434 | ||||||||
| FaxNumber: | 9733413437 | ||||||||
| Practice Location | |||||||||
| Address1: | 1027 POMPTON AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | CEDAR GROVE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070091155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9733413434 | ||||||||
| FaxNumber: | 9733413437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2014 | ||||||||
| LastUpdateDate: | 09/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | MONTEMURRO | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9733413434 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MA05893500 | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 6043208 | 05 | NJ | MEDICAID |