Provider Demographics
NPI:1962069567
Name:MONDESTIN, CARMEL ANGELY (MD)
Entity type:Individual
Prefix:
First Name:CARMEL
Middle Name:ANGELY
Last Name:MONDESTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ANGELY
Other - Middle Name:
Other - Last Name:MONDESTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12 TIMBER KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON CROSSING
Mailing Address - State:PA
Mailing Address - Zip Code:18977-1000
Mailing Address - Country:US
Mailing Address - Phone:267-221-6587
Mailing Address - Fax:
Practice Address - Street 1:259 1ST ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:516-663-8443
Practice Address - Fax:516-663-8955
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11574100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics