Provider Demographics
NPI:1336657907
Name:MONGE, HEATHER ALICIA
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ALICIA
Last Name:MONGE
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 1:100 HOLLAND CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7551
Mailing Address - Country:US
Mailing Address - Phone:518-842-3800
Mailing Address - Fax:518-842-3900
Practice Address - Street 1:100 HOLLAND CIRCLE DR
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7551
Practice Address - Country:US
Practice Address - Phone:518-842-3800
Practice Address - Fax:518-842-3900
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008722152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist