Montana Len Northcutt, cnim
Specialist/Technologist, Other in Hauppauge, NY. Individual provider (NPI-1).
NPI number1164096426
StatusActive
Last updated in NPPESMay 19, 2021
Details
- NPI
- 1164096426
- Entity type
- Individual (NPI-1)
- Name
- Montana Len Northcutt
- Credential
- cnim
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 19, 2021
- Certification date
- May 19, 2021
- Last updated
- May 19, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 246Z00000X | Specialist/Technologist, Other | – | NY | Yes |
Practice location
140 Adams AveHauppauge, NY 11788-3618
Phone 631-617-6011
Mailing address
140 Adams AveHauppauge, NY 11788-3618
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