Healthcare Provider Details

I. General information

NPI: 1861329773
Provider Name (Legal Business Name): JOSEPH FRANK MAMOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4513 MANHATTAN COLLEGE PKWY
BRONX NY
10471-4004
US

IV. Provider business mailing address

323 W 75TH ST
NEW YORK NY
10023-1651
US

V. Phone/Fax

Practice location:
  • Phone: 718-862-7226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number004749-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: