MEDICARE: J. LAMENDOLA PHYSICAL THERAPY, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	02025341	NY

General Provider Information

NPI Number	:	1982004958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J. LAMENDOLA PHYSICAL THERAPY, P.C.

Provider Business Mailing Address
First Line	:	1100 CLOVE RD
Second Line	:	SUITE GC
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3648
Country	:	US
Telephone Number	:	718-816-6500
Fax Number	:	718-816-4677

Provider Business Practice Location Address
First Line	:	1100 CLOVE RD
Second Line	:	SUITE GC
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3648
Country	:	US
Telephone Number	:	718-816-6500
Fax Number	:	718-816-4677

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MR. JASON PAUL LAMENDOLA
Credential	:	P.T.
Telephone Number	:	718-816-6500

Provider Enumeration Date	:	08/27/2014
Last Update Date	:	08/08/2022

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