Provider Demographics
NPI:1679509665
Name:JEAN-BAPTISTE, MONALISA (MD)
Entity Type:Individual
Prefix:
First Name:MONALISA
Middle Name:
Last Name:JEAN-BAPTISTE
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 1:1318 E 66TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5619
Mailing Address - Country:US
Mailing Address - Phone:718-241-6304
Mailing Address - Fax:
Practice Address - Street 1:5000 AVENUE K
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2202
Practice Address - Country:US
Practice Address - Phone:718-968-1515
Practice Address - Fax:718-209-2295
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193644174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01898879Medicaid
NYMJ09L05010Medicare ID - Type Unspecified
NY01898879Medicaid