Healthcare Provider Details

I. General information

NPI: 1750785416
Provider Name (Legal Business Name): JOHN J POMPONIO- CARECCIA ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9216 7TH AVE
BROOKLYN NY
11228-3622
US

IV. Provider business mailing address

497 MEDINA ST
STATEN ISLAND NY
10306-4452
US

V. Phone/Fax

Practice location:
  • Phone: 718-836-9800
  • Fax: 718-748-5436
Mailing address:
  • Phone: 718-836-9800
  • Fax: 718-748-5436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number001484-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: