Provider Demographics
NPI:1366858318
Name:DUPREE, MONIQUE SHANNELL (DPT)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:SHANNELL
Last Name:DUPREE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 DEMOREST AVE
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1203
Mailing Address - Country:US
Mailing Address - Phone:908-380-0731
Mailing Address - Fax:
Practice Address - Street 1:12 W 37TH ST
Practice Address - Street 2:SUITE 1202
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7480
Practice Address - Country:US
Practice Address - Phone:212-777-4374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037007225100000X
NJ40QA01533500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist