Provider Demographics
NPI:1205015542
Name:SATISH K MONGIA MD PC
Entity Type:Organization
Organization Name:SATISH K MONGIA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER/ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:FAITH/CLAUDIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SENSKE/ TOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-487-1161
Mailing Address - Street 1:320 PRATHER AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6820
Mailing Address - Country:US
Mailing Address - Phone:716-487-1161
Mailing Address - Fax:716-487-1163
Practice Address - Street 1:320 PRATHER AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6820
Practice Address - Country:US
Practice Address - Phone:716-487-1161
Practice Address - Fax:716-487-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1237912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00631021Medicaid
NYB71543OtherUPIN
NYB71543OtherUPIN