Provider Demographics
NPI:1750364832
Name:MONAGHAN, MICHELLE (PA)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:MONAGHAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1236
Mailing Address - Country:US
Mailing Address - Phone:718-909-5988
Mailing Address - Fax:
Practice Address - Street 1:28 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1236
Practice Address - Country:US
Practice Address - Phone:718-909-5988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006035363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYZ80921Medicare ID - Type Unspecified
NYS53318Medicare UPIN