Basic Information
| Provider Information | |||||||||
| NPI: | 1891921706 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAMIDWAR | ||||||||
| FirstName: | MONIKA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 MONTGOMERY ST APT 16E | ||||||||
| Address2: | |||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073024628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322664029 | ||||||||
| FaxNumber: | 7187801300 | ||||||||
| Practice Location | |||||||||
| Address1: | 339 HICKS ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112015509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187801881 | ||||||||
| FaxNumber: | 7187801300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2009 | ||||||||
| LastUpdateDate: | 02/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 277922-1 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD18028 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 265077 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 69211 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 1043 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 01086620A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2021036342 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 25MA09146300 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | NY00000 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 72176-20 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.