Provider Demographics
NPI:1164447587
Name:UY, LORETA MONTOLO (MD)
Entity type:Individual
Prefix:DR
First Name:LORETA
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 1:66 SOMME ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-3612
Mailing Address - Country:US
Mailing Address - Phone:973-589-7337
Mailing Address - Fax:973-589-1905
Practice Address - Street 1:66 SOMME ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-3612
Practice Address - Country:US
Practice Address - Phone:973-589-7337
Practice Address - Fax:973-589-1905
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA055049002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3438708Medicaid
NJ25MA05504900OtherMEDICAL LICENSE