Provider Demographics
NPI:1407982986
Name:MONDESIR, MARIE (RN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MONDESIR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 EMILY AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4223
Mailing Address - Country:US
Mailing Address - Phone:516-343-7699
Mailing Address - Fax:845-635-6007
Practice Address - Street 1:89 EMILY AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4223
Practice Address - Country:US
Practice Address - Phone:516-343-7699
Practice Address - Fax:516-352-3977
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY480884163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02374945Medicaid