Healthcare Provider Details

I. General information

NPI: 1194384644
Provider Name (Legal Business Name): MONICA THI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2019
Last Update Date: 11/29/2020
Certification Date: 11/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 NEWARK AVE STE 1
JERSEY CITY NJ
07302-5862
US

IV. Provider business mailing address

127 NEWARK AVE
JERSEY CITY NJ
07302-5862
US

V. Phone/Fax

Practice location:
  • Phone: 201-333-2768
  • Fax:
Mailing address:
  • Phone: 201-333-2768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00690100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: