Provider Demographics
NPI:1255763447
Name:ELDAHRY, MONA KAMAL (LAC)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:KAMAL
Last Name:ELDAHRY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 OCEAN AVE APT 38
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5351
Mailing Address - Country:US
Mailing Address - Phone:917-703-0488
Mailing Address - Fax:347-789-3025
Practice Address - Street 1:32 COURT ST STE 705
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4404
Practice Address - Country:US
Practice Address - Phone:917-703-0488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005060-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist