Healthcare Provider Details

I. General information

NPI: 1992944706
Provider Name (Legal Business Name): MONIQUE RICHARDSON MEDICAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 MAIN STREET HEMPSTEAD COMMUNITY HEALTH CENTER
HEMPSTEAD NY
11550
US

IV. Provider business mailing address

135 MAIN STREET HEMPSTEAD COMMUNITY HEALTH CENTER
HEMPSTEAD NY
11550
US

V. Phone/Fax

Practice location:
  • Phone: 516-572-1300
  • Fax: 516-572-5793
Mailing address:
  • Phone: 516-572-1300
  • Fax: 516-572-5793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: