Provider Demographics
NPI:1700897808
Name:MONKCOM, WENDY A (MD)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:A
Last Name:MONKCOM
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 1:535 2ND AVE
Mailing Address - Street 2:KIPS BAY ENDOSCOPY CENTER LLC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8275
Mailing Address - Country:US
Mailing Address - Phone:212-889-5477
Mailing Address - Fax:212-889-0517
Practice Address - Street 1:535 2ND AVE
Practice Address - Street 2:KIPS BAY ENDOSCOPY CENTER LLC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8275
Practice Address - Country:US
Practice Address - Phone:212-889-5477
Practice Address - Fax:212-889-0517
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY102431207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D47670Medicare UPIN
NY525511Medicare ID - Type Unspecified