Provider Demographics
NPI:1215140447
Name:BINFORD, MONIQUE RENEE (NP)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:RENEE
Last Name:BINFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1022
Mailing Address - Country:US
Mailing Address - Phone:631-608-3511
Mailing Address - Fax:631-842-2039
Practice Address - Street 1:71 WALNUT RD
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-1022
Practice Address - Country:US
Practice Address - Phone:631-608-3511
Practice Address - Fax:631-842-2039
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302127363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS67492Medicare UPIN