Provider Demographics
NPI:1366590788
Name:MONTUORI, GERARD ROCCO (MD)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:ROCCO
Last Name:MONTUORI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 KAKIAK CT
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4534
Mailing Address - Country:US
Mailing Address - Phone:845-639-7614
Mailing Address - Fax:845-639-1250
Practice Address - Street 1:115 BROADWAY
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-2835
Practice Address - Country:US
Practice Address - Phone:914-693-6800
Practice Address - Fax:914-693-1731
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY170608207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01108341Medicaid
NY01108341Medicaid
D92145Medicare UPIN