Provider Demographics
NPI:1316992019
Name:MONTANEZ, RUBEN (APRN, PCNS)
Entity type:Individual
Prefix:PROF
First Name:RUBEN
Middle Name:
Last Name:MONTANEZ
Suffix:
Gender:M
Credentials:APRN, PCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 MAIN ST FL 400
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1063
Mailing Address - Country:US
Mailing Address - Phone:413-739-5572
Mailing Address - Fax:
Practice Address - Street 1:1695 MAIN ST FL 400
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1063
Practice Address - Country:US
Practice Address - Phone:413-739-5572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3149972363LP0808X
NY401791363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL761408000Medicaid
FL761408000Medicaid
FLP32986Medicare UPIN
FLE5633PMedicare UPIN