Provider Demographics
NPI:1063435501
Name:UY, LOLITA MONTOLO (MD)
Entity type:Individual
Prefix:DR
First Name:LOLITA
Middle Name:MONTOLO
Last Name:UY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3553 77TH ST
Mailing Address - Street 2:APT. 2-B
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-4551
Mailing Address - Country:US
Mailing Address - Phone:718-457-7998
Mailing Address - Fax:
Practice Address - Street 1:3553 77TH ST
Practice Address - Street 2:2-B
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-4551
Practice Address - Country:US
Practice Address - Phone:718-457-7998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186048208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01854475Medicaid
NY02806Medicare ID - Type Unspecified
NY01854475Medicaid