Active NPI
Michael Montanez
- Prevention Professional
- New York, NY
National Provider Identifier
1235744012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- T155768
- Practice address
- 101 W 123Rd St
New York, NY 10027-5511 - Phone
- (212) 662-5536
- NPI assigned
- Sep 9, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prevention Professional | 405300000X | T155768 | NY | Primary |
Addresses
Primary practice location
101 W 123Rd St
New York, NY 10027-5511
Mailing address
1309 5TH Ave Apt 25E
New York, NY 10029-3127
Phone (646) 389-0063
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T155768 | NY | MD | Prevention Professional |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Preventive Lifestyle Assistance Network Marci Kenon Sole MBR | Prevention Professional | Current | Accepting new patients |
Locations
101 W 123rd St
New York, NY 10027
Phone (212) 662-5536
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Prevention Professional
- New York, NY
- NPI 1730716937
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599609600000",
"number": "1235744012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1309 5TH AVE APT 25E",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100293127",
"telephone_number": "646-389-0063"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 W 123RD ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100275511",
"telephone_number": "212-662-5536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTANEZ",
"first_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-09",
"last_updated": "2020-09-09",
"certification_date": "2020-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "NY",
"license": "T155768",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.