Provider Demographics
NPI:1144215559
Name:PERVIL-ULYSSE, MONA (MD)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:
Last Name:PERVIL-ULYSSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2229
Mailing Address - Country:US
Mailing Address - Phone:718-768-3383
Mailing Address - Fax:718-768-2117
Practice Address - Street 1:182 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2229
Practice Address - Country:US
Practice Address - Phone:718-768-3383
Practice Address - Fax:718-768-2117
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187762-1207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01369906Medicaid
NY69K733Medicare ID - Type Unspecified
NY01369906Medicaid