Provider Demographics
NPI:1891921706
Name:MAMIDWAR, MONIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:
Last Name:MAMIDWAR
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 1:135 MONTGOMERY ST APT 16E
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4628
Mailing Address - Country:US
Mailing Address - Phone:732-266-4029
Mailing Address - Fax:718-780-1300
Practice Address - Street 1:339 HICKS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5509
Practice Address - Country:US
Practice Address - Phone:718-780-1881
Practice Address - Fax:718-780-1300
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277922-1207R00000X
RIMD18028207R00000X
NC265077207R00000X
CT69211207R00000X
FL1043207R00000X
IN01086620A207R00000X
MO2021036342207R00000X
NJ25MA09146300207R00000X
NYNY00000207R00000X
WI72176-20207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine