1568878809 NPI number — CHRISTINA MONDELLA M.S. TSSLD

Table of content: AMY E DUMONT ARNP (NPI 1184670853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568878809 NPI number — CHRISTINA MONDELLA M.S. TSSLD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONDELLA
Provider First Name:
CHRISTINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S. TSSLD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MURRAY
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S. TSSLD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568878809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 IDLEWILD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABERDEEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07747-1533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-354-6267
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98 DOGWOOD LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10305-2813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-737-8901
Provider Business Practice Location Address Fax Number:
718-815-8121
Provider Enumeration Date:
07/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  024960 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04587202 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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