Individual
DR. RUSSELL JOSEPH MONGIOVI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
3 HEMPHILL PL, MALTA, NY 12020-4419
(518) 899-3338
(518) 899-5025
Mailing address
3 HEMPHILL PL, MALTA, NY 12020-4420
(518) 899-3338
(518) 899-5025
Taxonomy
Speciality
Code
Description
License number
State
213ES0000X
Sports Medicine Podiatrist
Primary
N004782
NY
Other
Enumeration date
06/23/2006
Last updated
07/08/2007
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