Provider Demographics
NPI:1548488497
Name:NOISY ST VICTOR, MONIQUE (CPNP MSN)
Entity type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:
Last Name:NOISY ST VICTOR
Suffix:
Gender:F
Credentials:CPNP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 CRAIG AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520
Mailing Address - Country:US
Mailing Address - Phone:516-867-2140
Mailing Address - Fax:
Practice Address - Street 1:401 W 164 ST
Practice Address - Street 2:RM 313
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-740-0130
Practice Address - Fax:212-543-2237
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380056363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00243178Medicaid