Provider Demographics
NPI:1750643607
Name:JELKS, MONA (STATE CERTIFICATION)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:
Last Name:JELKS
Suffix:
Gender:F
Credentials:STATE CERTIFICATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 58 ROSSER AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003
Mailing Address - Country:US
Mailing Address - Phone:917-833-0756
Mailing Address - Fax:
Practice Address - Street 1:14 58 ROSSER AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003
Practice Address - Country:US
Practice Address - Phone:917-833-0756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator