1588690747 NPI number — GERALD J MONCHIK MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588690747 NPI number — GERALD J MONCHIK MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MONCHIK

Provider First Name:

GERALD

Provider Middle Name:

J

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1588690747

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/23/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1030 PRESIDENT AVE

Provider Second Line Business Mailing Address:

SUITE 3002

Provider Business Mailing Address City Name:

FALL RIVER

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

02720-5923

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

508-676-3411

Provider Business Mailing Address Fax Number:

508-676-0932

Provider First Line Business Practice Location Address:

1030 PRESIDENT AVE

Provider Second Line Business Practice Location Address:

SUITE 3002

Provider Business Practice Location Address City Name:

FALL RIVER

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

02720-5923

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

508-676-3411

Provider Business Practice Location Address Fax Number:

508-676-0932

Provider Enumeration Date:

06/22/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208600000X , with the licence number:  MA37145 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1701012 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
• Identifier: 202000 . This is a "BLUE CHIP" identifier . This identifiers is of the category "OTHER".
• Identifier: GM07816 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
• Identifier: 3427518 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 2019914 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 7111118003 . This is a "CIGNA FOR REFERRALS" identifier . This identifiers is of the category "OTHER".
• Identifier: 8157 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".
• Identifier: 020013711 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 037145 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
• Identifier: 000000021261 . This is a "BMC" identifier . This identifiers is of the category "OTHER".
• Identifier: 000367 . This is a "SWH" identifier . This identifiers is of the category "OTHER".
• Identifier: 0027846 . This is a "NHP" identifier . This identifiers is of the category "OTHER".
• Identifier: B20914702 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: K08288 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".