Provider Demographics
NPI:1902915044
Name:DANA O. MONACO, MD, PC
Entity type:Organization
Organization Name:DANA O. MONACO, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:O
Authorized Official - Last Name:MONACO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-766-8600
Mailing Address - Street 1:2 SAINT CLAIR ST
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1719
Mailing Address - Country:US
Mailing Address - Phone:516-766-8600
Mailing Address - Fax:516-766-8858
Practice Address - Street 1:2000 N VILLAGE AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1078
Practice Address - Country:US
Practice Address - Phone:516-766-8600
Practice Address - Fax:516-766-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163611-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF71353Medicare UPIN
NY15I541Medicare ID - Type Unspecified