Provider Demographics
NPI:1487654273
Name:MONTALBANO, GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:MONTALBANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 LAMBERTS LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7210
Mailing Address - Country:US
Mailing Address - Phone:718-477-5479
Mailing Address - Fax:718-761-1770
Practice Address - Street 1:82 LAMBERTS LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7210
Practice Address - Country:US
Practice Address - Phone:718-477-5479
Practice Address - Fax:718-761-1770
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198286207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1863396OtherUHC
NY01902625Medicaid
6016151OtherGHI
2022777OtherAETNA
6016151OtherGHI
G78640Medicare UPIN
NY4078450001Medicare NSC