Provider Demographics
NPI:1053555227
Name:MONDA, MARIA BIANCA (APN)
Entity type:Individual
Prefix:PROF
First Name:MARIA
Middle Name:BIANCA
Last Name:MONDA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3522
Mailing Address - Country:US
Mailing Address - Phone:201-368-3480
Mailing Address - Fax:
Practice Address - Street 1:288 BOULEVARD
Practice Address - Street 2:
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-1319
Practice Address - Country:US
Practice Address - Phone:201-288-6781
Practice Address - Fax:201-288-2734
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00192900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00192900OtherCERT