Provider Demographics
NPI:1336539279
Name:GAJIWALA, MONIKA (LAC)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:GAJIWALA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 2ND AVE
Mailing Address - Street 2:SUITE # 9
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2739
Mailing Address - Country:US
Mailing Address - Phone:201-675-1397
Mailing Address - Fax:
Practice Address - Street 1:303 2ND AVE
Practice Address - Street 2:SUITE # 9
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2739
Practice Address - Country:US
Practice Address - Phone:201-675-1397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005473171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist