Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 403399 | NY |
NPI | 1033744404 |
---|---|
Provider Name | Roman Mondal |
First Address | Long Island City, NY 11101-3050 |
Second Address | Long Island City, NY 11101-3050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2020 |
Last Update Date | 15/06/2021 |