Basic Information
| Provider Information | |||||||||
| NPI: | 1134133317 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONAGHAN | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 MARCUS AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110421008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166226000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2800 MARCUS AVENUE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LAKE SUCCESS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166226161 | ||||||||
| FaxNumber: | 5166226171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 004935 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.