Individual
MONDALE LUCAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
111 COLLEGE RD APT 9P, SELDEN, NY 11784-2836
(631) 764-3716
Mailing address
111 COLLEGE RD APT 9P, SELDEN, NY 11784-2836
(631) 764-3716
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
819750
NY
Other
Enumeration date
07/30/2021
Last updated
07/30/2021
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