MEDICARE: GERALD MONDARES PT

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	019653	NY

General Provider Information

NPI Number	:	1972136547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD MONDARES PT

Provider Business Mailing Address
First Line	:	321 EDISON ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-3023
Country	:	US
Telephone Number	:	718-967-6205
Fax Number	:	718-966-4382

Provider Business Practice Location Address
First Line	:	321 EDISON ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-3023
Country	:	US
Telephone Number	:	718-966-7940
Fax Number	:	718-966-4382

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

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	04/29/2022

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