Healthcare Provider Details

I. General information

NPI: 1437361896
Provider Name (Legal Business Name): DEBBRA AMES MONCHIK NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

45 HASTINGS CT
STATEN ISLAND NY
10309-3552
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-9181
  • Fax:
Mailing address:
  • Phone: 917-699-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF332493
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: