MEDICARE: JOIA MINGO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	031958	NY

General Provider Information

NPI Number	:	1558750034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOIA MINGO

Provider Business Mailing Address
First Line	:	PO BOX 114
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10552-0114
Country	:	US
Telephone Number	:	914-775-9400
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 FLEETWOOD AVE
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10552-7645
Country	:	US
Telephone Number	:	914-775-9400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2015
Last Update Date	:	09/01/2020

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Directions to “ JOIA MINGO ” Practice Location

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