Provider Demographics
NPI:1487786646
Name:BEAN, MONIQUE NICOLE (OD)
Entity type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:NICOLE
Last Name:BEAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-1207
Mailing Address - Country:US
Mailing Address - Phone:917-714-4087
Mailing Address - Fax:
Practice Address - Street 1:847 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-1338
Practice Address - Country:US
Practice Address - Phone:718-604-1002
Practice Address - Fax:718-604-1027
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006024152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU72799Medicare UPIN
NYC53921Medicare ID - Type Unspecified