=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013305655
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT VINCENT DI MONDA MS, ATC, EMT-B
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2015
-----------------------------------------------------
Last Update Date | 01/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 HOFSTRA UNIVERSITY
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11549-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-463-6769
-----------------------------------------------------
Fax | 516-463-6061
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 DUNSTAN DR
-----------------------------------------------------
City | MERRICK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11566-1416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-282-6242
-----------------------------------------------------
Fax | 516-463-6061
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 001528-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------