Healthcare Provider Details

I. General information

NPI: 1184387979
Provider Name (Legal Business Name): MONICA KOBAYASHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 01/09/2022
Certification Date: 01/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3767 RICHMOND AVE
STATEN ISLAND NY
10312-3827
US

IV. Provider business mailing address

127 KEEGANS LN
STATEN ISLAND NY
10308-3045
US

V. Phone/Fax

Practice location:
  • Phone: 347-449-8502
  • Fax:
Mailing address:
  • Phone: 347-449-8502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number030288
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: