Healthcare Provider Details

I. General information

NPI: 1780273482
Provider Name (Legal Business Name): MONIQUE FOURE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2021
Last Update Date: 01/16/2021
Certification Date: 01/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W 24TH ST APT 20A
NEW YORK NY
10011-1578
US

IV. Provider business mailing address

311 W 24TH ST APT 20A
NEW YORK NY
10011-1578
US

V. Phone/Fax

Practice location:
  • Phone: 917-498-6489
  • Fax:
Mailing address:
  • Phone: 917-498-6489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: