Individual
DR. ANDRE H. MONTAZEM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 GUSTAVE L LEVY PL, BOX 1187, NEW YORK, NY 10029-6500
(212) 241-0316
Mailing address
54 ROOSEVELT AVE, HAWTHORNE, NJ 07506-1539
(862) 684-5578
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
208721
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01795293
—
NY
Enumeration date
04/06/2006
Last updated
07/08/2007
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