Provider Demographics
NPI:1902005911
Name:COLLIER, MONIQUE JASMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:JASMIN
Last Name:COLLIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MONIQUE
Other - Middle Name:JASMIN
Other - Last Name:NICKLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3415 BAINBRIDGE AVE
Mailing Address - Street 2:DIVISION OF ADOLESCENT MEDICINE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2403
Mailing Address - Country:US
Mailing Address - Phone:718-920-2180
Mailing Address - Fax:718-920-5289
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-741-2450
Practice Address - Fax:718-944-5362
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2387902080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine