Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 251165 | NY |
NPI | 1063409621 |
---|---|
Provider Name | Mon Vera |
First Address | New York, NY 10022-3301 |
Second Address | New York, NY 10022-3305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 12/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03093390 | (05) | NY |
1003236 | CIGNA/GREAT WEST (01) | NY |
VR1165 | ATLANTIS (01) | NY |