Healthcare Provider Details

I. General information

NPI: 1194708768
Provider Name (Legal Business Name): STEVEN L MENDOLA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3999 RICHMOND AVE
STATEN ISLAND NY
10312-5112
US

IV. Provider business mailing address

3999 RICHMOND AVE
STATEN ISLAND NY
10312-5112
US

V. Phone/Fax

Practice location:
  • Phone: 718-356-8890
  • Fax: 718-356-8247
Mailing address:
  • Phone: 718-356-8890
  • Fax: 718-356-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number007032-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: