Healthcare Provider Details

I. General information

NPI: 1912913617
Provider Name (Legal Business Name): MONICA FURLONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 FRONTIER NE SURGE BLDG. 1-WEST
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

2701 FRONTIER NE MSC11 6120
ALBUQUERQUE NM
87106
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2610
  • Fax:
Mailing address:
  • Phone: 505-272-2610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2003-0411
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: