Provider Demographics
NPI:1073747630
Name:DAVIDOFF, MONIQUE M (MS, OTRL)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:M
Last Name:DAVIDOFF
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 AMAGANSETT DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1182
Mailing Address - Country:US
Mailing Address - Phone:617-823-9558
Mailing Address - Fax:
Practice Address - Street 1:25 E WILLOW ST
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1416
Practice Address - Country:US
Practice Address - Phone:973-564-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00450300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist