Provider Demographics
NPI:1922182583
Name:MONA VANI MD PC
Entity Type:Organization
Organization Name:MONA VANI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:T
Authorized Official - Last Name:VANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-475-0332
Mailing Address - Street 1:285 SILLS RD
Mailing Address - Street 2:BUILDING 9 SUITE A
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4869
Mailing Address - Country:US
Mailing Address - Phone:631-475-0344
Mailing Address - Fax:631-475-2852
Practice Address - Street 1:285 SILLS RD
Practice Address - Street 2:BUILDING 9 SUITE A
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4869
Practice Address - Country:US
Practice Address - Phone:631-475-0344
Practice Address - Fax:631-475-2852
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONA VANI MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-24
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty