Individual
LESLIE MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 NOBLE AVE, APT 10C, BRONX, NY 10460-3107
(347) 431-2880
Mailing address
1466 BEACH AVE APT 12A, BRONX, NY 10460-3622
(347) 431-2880
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
814016687
DURABLE MEDICAL EQUIPMENT SUPPLIER
NY
Enumeration date
09/30/2016
Last updated
09/30/2016
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