Provider Demographics
NPI:1871369439
Name:MONTGOMERY-MANN, AMBER LYNN
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:MONTGOMERY-MANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 S VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-1214
Mailing Address - Country:US
Mailing Address - Phone:631-317-7005
Mailing Address - Fax:
Practice Address - Street 1:53 S VILLAGE DR
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-1214
Practice Address - Country:US
Practice Address - Phone:631-317-7005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker