Provider Demographics
NPI:1538197033
Name:BREINDEL, MONIQUE LEE (MD)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:LEE
Last Name:BREINDEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 5TH AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5210
Mailing Address - Country:US
Mailing Address - Phone:212-241-6336
Mailing Address - Fax:212-241-5658
Practice Address - Street 1:1212 5TH AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5210
Practice Address - Country:US
Practice Address - Phone:212-241-6336
Practice Address - Fax:212-241-5658
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1514772083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY151477OtherLICENSE
NY151477OtherLICENSE
4Y5141Medicare ID - Type Unspecified