Healthcare Provider Details

I. General information

NPI: 1619381951
Provider Name (Legal Business Name): MONIQUE REMBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2014
Last Update Date: 06/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 PROSPECT AVE
BUFFALO NY
14201-2358
US

IV. Provider business mailing address

70 PROSPECT AVE
BUFFALO NY
14201-2358
US

V. Phone/Fax

Practice location:
  • Phone: 607-651-6648
  • Fax:
Mailing address:
  • Phone: 607-651-6648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: