Provider Demographics
NPI:1376519926
Name:MOMMSEN, MONIKA R A (MD)
Entity Type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:R A
Last Name:MOMMSEN
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 1:10 HELLBROOK LN
Mailing Address - Street 2:
Mailing Address - City:ULSTER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12487-5209
Mailing Address - Country:US
Mailing Address - Phone:845-658-7763
Mailing Address - Fax:
Practice Address - Street 1:105 WOODCREST DR
Practice Address - Street 2:
Practice Address - City:RIFTON
Practice Address - State:NY
Practice Address - Zip Code:12471-7200
Practice Address - Country:US
Practice Address - Phone:845-658-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01062977Medicaid
NY171044OtherHMO
NY5287OtherPIN FOR NEWBORN SCREENING
NY5287OtherPIN FOR NEWBORN SCREENING
NY171044OtherHMO
NY15E001Medicare ID - Type Unspecified