Provider Demographics
NPI:1134528706
Name:GADIDOV, MONICA M (DENTIST)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:M
Last Name:GADIDOV
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 EAST 38TH ST.
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-685-9243
Mailing Address - Fax:212-685-9243
Practice Address - Street 1:155 EAST 38TH ST.
Practice Address - Street 2:SUITE 2F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-685-9243
Practice Address - Fax:212-685-9243
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0366601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice