Healthcare Provider Details

I. General information

NPI: 1609851104
Provider Name (Legal Business Name): KAREN SUE MONES M.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GROSVENOR PL
GREAT NECK NY
11021-4535
US

IV. Provider business mailing address

10 GROSVENOR PL
GREAT NECK NY
11021-4535
US

V. Phone/Fax

Practice location:
  • Phone: 516-487-0068
  • Fax: 516-561-7515
Mailing address:
  • Phone: 516-487-0068
  • Fax: 516-561-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number179662
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: