Dr. Russell Joseph Mongiovi, DPM
Podiatrist, Sports Medicine in Malta, NY. Individual provider (NPI-1).
NPI number1104852136
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1104852136
- Entity type
- Individual (NPI-1)
- Name
- Dr. Russell Joseph Mongiovi
- Credential
- DPM
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 23, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 213ES0000X | Podiatrist, Sports Medicine | N004782 | NY | Yes |
Practice location
3 Hemphill PlMalta, NY 12020-4419
Phone 518-899-3338 · Fax 518-899-5025
Mailing address
3 Hemphill PlMalta, NY 12020-4420
Phone 518-899-3338 · Fax 518-899-5025
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