Healthcare Provider Details

I. General information

NPI: 1003753476
Provider Name (Legal Business Name): JEAN-ARLY MONDESIR RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 BLAIR DR
CORAM NY
11727-2267
US

IV. Provider business mailing address

29 BLAIR DR
CORAM NY
11727-2267
US

V. Phone/Fax

Practice location:
  • Phone: 917-749-6854
  • Fax:
Mailing address:
  • Phone: 917-749-6854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number008497
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: