Provider Demographics
NPI:1932474897
Name:GEORGES-PERDOMO, MONA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MONA
Middle Name:
Last Name:GEORGES-PERDOMO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 CORPORAL KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1061
Mailing Address - Country:US
Mailing Address - Phone:718-279-1865
Mailing Address - Fax:718-423-9566
Practice Address - Street 1:3224 CORPORAL KENNEDY ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1061
Practice Address - Country:US
Practice Address - Phone:718-279-1865
Practice Address - Fax:718-423-9566
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY466951163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool