Provider Demographics
NPI:1114086998
Name:MOUKALA-CADET, ANNE-MARIE LAURE (DO)
Entity Type:Individual
Prefix:
First Name:ANNE-MARIE
Middle Name:LAURE
Last Name:MOUKALA-CADET
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANNE-MARIE
Other - Middle Name:LAURE
Other - Last Name:MOUKALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1994 DONNA AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1444
Mailing Address - Country:US
Mailing Address - Phone:607-239-5603
Mailing Address - Fax:
Practice Address - Street 1:1302 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5430
Practice Address - Country:US
Practice Address - Phone:607-754-2323
Practice Address - Fax:607-754-1846
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02794705Medicaid
NY02794705Medicaid