Active NPI
Gerald Mondares, PT
- Physical Therapist
- Staten Island, NY
National Provider Identifier
1972136547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 019653
- Practice address
- 321 Edison St
Staten Island, NY 10306-3023 - Phone
- (718) 966-7940
- Fax
- (718) 966-4382
- NPI assigned
- Feb 21, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 019653 | NY | Primary |
Addresses
Primary practice location
321 Edison St
Staten Island, NY 10306-3023
Mailing address
321 Edison St
Staten Island, NY 10306-3023
Phone (718) 967-6205
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019653 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651190400000",
"number": "1972136547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "321 EDISON ST",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103063023",
"telephone_number": "718-967-6205",
"fax_number": "718-966-4382"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "321 EDISON ST",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103063023",
"telephone_number": "718-966-7940",
"fax_number": "718-966-4382"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONDARES",
"first_name": "GERALD",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-02-21",
"last_updated": "2022-04-29",
"certification_date": "2022-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "019653",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.