Individual provider Active NPI

Anne Marie Montijo, LCSW

  • Clinical Social Worker
  • Port Jefferson Station, NY
National Provider Identifier
1891904488
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R045239-1 Issued in NY
Practice address
1050 Hallock Ave
Port Jefferson Station, NY 11776-1214
Phone
(631) 428-6475
NPI assigned
May 21, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X R045239-1 NY Primary

Addresses

Primary practice location

1050 Hallock Ave
Port Jefferson Station, NY 11776-1214

Mailing address

3 Hale LN
Coram, NY 11727-2903
Phone (631) 428-6475

Other identifiers 1

IdentifierTypeStateIssuer
R045239-1OtherNYLICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040728000450 NY Practitioner - Clinical Social Worker 8022088053 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Meeting House Lane Medical Practice PCGroup PAC ID 6800972589, 125 clinicians

Practice addresses (Care Compare)

182 W Montauk Hwy
Suite B
Hampton Bays, NY 11946-4210
Phone (631) 594-3910

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R045239-1NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Meeting House Lane Medical Practice PC CurrentSince Apr 1, 2024 Accepting new patients

Locations

182 W Montauk Hwy
Ste B
Hampton Bays, NY 11946
Phone (631) 594-3910

325 Meeting House Ln
Ste 403
Southampton, NY 11968
Phone (631) 283-2100

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: anne.montijo.p12@direct.shproviders.nextgenshare.com

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891904488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 HALE LN",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117272903",
            "telephone_number": "631-428-6475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 HALLOCK AVE",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761214",
            "telephone_number": "631-428-6475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTIJO",
        "first_name": "ANNE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R045239-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "R045239-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

Verify at the official NPI Registry.