Individual
MRS. MONA BOULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2780 KENNEDY BLVD, JERSEY CITY, NJ 07306
(201) 239-7777
(201) 239-0070
Mailing address
3171 ROUTE 9 N, SUITE 313, OLD BRIDGE, NJ 08857-2690
(201) 239-7777
(201) 239-0070
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
25MA06214600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7186703
—
NJ
Enumeration date
09/15/2006
Last updated
01/18/2012
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