Provider Demographics
NPI:1831411222
Name:MOMEN, ISHRAT
Entity type:Individual
Prefix:
First Name:ISHRAT
Middle Name:
Last Name:MOMEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MERIWETHER TRL
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-1538
Mailing Address - Country:US
Mailing Address - Phone:845-267-0709
Mailing Address - Fax:
Practice Address - Street 1:274 OLD NYACK TPKE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5854
Practice Address - Country:US
Practice Address - Phone:845-371-4671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist