Provider Demographics
NPI:1093051922
Name:MONGIELLO, FRANK
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:MONGIELLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807
Mailing Address - Country:US
Mailing Address - Phone:908-930-0014
Mailing Address - Fax:
Practice Address - Street 1:256 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2676
Practice Address - Country:US
Practice Address - Phone:908-930-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJM64042670010592146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic