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General NPI Number Information
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NPI Number | 1639041023
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Entity Type | Individual
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Provider Name | NICHOLAS MONDORE PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/23/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 1367 WASHINGTON AVE STE 200
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City | ALBANY
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State | NY
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Zip | 12206-1043
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Country | US
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Telephone | 518-489-2666
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Fax |
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Provider Business Mailing Address
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Address Line | 1703 FOREST RIDGE BLVD
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-7432
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Country | US
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Telephone | 315-939-9943
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | NY
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