Provider Demographics
NPI:1396983037
Name:MONTOYA, EDWARD (DPM)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3317
Mailing Address - Country:US
Mailing Address - Phone:908-275-7882
Mailing Address - Fax:908-264-0772
Practice Address - Street 1:300 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3317
Practice Address - Country:US
Practice Address - Phone:908-275-7882
Practice Address - Fax:908-264-0772
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00299600213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ181996Medicare PIN