1043677925 NPI number — MONIKA SRIVASTAVA DMD PA EAST

Table of content: (NPI 1043677925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043677925 NPI number — MONIKA SRIVASTAVA DMD PA EAST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONIKA SRIVASTAVA DMD PA EAST
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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 Information

NPI Number:
1043677925
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10051 PINES BLVD STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBROKE PINES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33024-6172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-251-2717
Provider Business Mailing Address Fax Number:
954-613-4005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10051 PINES BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33024-6186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-251-2717
Provider Business Practice Location Address Fax Number:
954-613-4005
Provider Enumeration Date:
01/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SRIVASTAVA
Authorized Official First Name:
MONIKA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
215-485-7069

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003557500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016576400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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