MEDICARE: MS. MONIFA A DAVIS R.P.A.-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	013128-1	NY

General Provider Information

NPI Number	:	1306165931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MONIFA A DAVIS R.P.A.-C

Provider Business Mailing Address
First Line	:	555 W 57TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-2925
Country	:	US
Telephone Number	:	212-420-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 W 57TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-2925
Country	:	US
Telephone Number	:	212-420-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2010
Last Update Date	:	05/21/2010

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