Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 037581 | NY |
Y | 213EG0000X | General Practice | 037581 | NY |
NPI | 1003839556 |
---|---|
Provider Name | Dr. James R Mongiello |
First Address | Kings Park, NY 11754-3704 |
Second Address | Kings Park, NY 11754-3704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |