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General NPI Number Information
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NPI Number | 1255167136
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Entity Type | Individual
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Provider Name | PHILIP MONGELLUZZO III PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 233 MALCOLM X BLVD
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City | NEW YORK
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State | NY
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Zip | 10027-6498
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Country | US
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Telephone | 212-222-6525
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Fax |
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Provider Business Mailing Address
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Address Line | 6864 YELLOWSTONE BLVD APT A23
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City | FOREST HILLS
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State | NY
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Zip | 11375-3330
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 053069-01
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License Number State | NY
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