Healthcare Provider Details

I. General information

NPI: 1144687716
Provider Name (Legal Business Name): MOHAWK MONTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CHURCH STREET #365
AMSTERDAM NY
12010-0365
US

IV. Provider business mailing address

PO BOX 365
AMSTERDAM NY
12010-0365
US

V. Phone/Fax

Practice location:
  • Phone: 518-842-2990
  • Fax:
Mailing address:
  • Phone: 518-842-2990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDIE J ZAJACESKOWSKI
Title or Position: CHAIRMAN/DIRECTOR
Credential:
Phone: 518-842-6701