MEDICARE: DR. MONA NICOLAE M.D.

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	2084P0804X	Child & Adolescent Psychiatry Physician	225052-1	NY

General Provider Information

NPI Number	:	1679516991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONA NICOLAE M.D.

Provider Business Mailing Address
First Line	:	229 MYRTLE AVE
Second Line	:
City	:	WESTFIELD
State	:	NJ
Zip	:	07090-1500
Country	:	US
Telephone Number	:	914-473-4282
Fax Number	:	603-909-7716

Provider Business Practice Location Address
First Line	:	104 E 40TH ST RM 802
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-1801
Country	:	US
Telephone Number	:	212-682-2950
Fax Number	:

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/08/2007

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