Provider Demographics
NPI:1699934729
Name:APOLLON, MONIQUE RACHELLE (DO)
Entity type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:RACHELLE
Last Name:APOLLON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 NASSAU RD
Mailing Address - Street 2:LONG ISLAND FQHC, INC.
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-1343
Mailing Address - Country:US
Mailing Address - Phone:516-571-8600
Mailing Address - Fax:
Practice Address - Street 1:161 HEMPSTEAD TPKE
Practice Address - Street 2:LONG ISLAND FQHC, INC.
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1432
Practice Address - Country:US
Practice Address - Phone:516-571-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03052068Medicaid