Provider Demographics
NPI:1235153164
Name:MUNGARI, JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:MUNGARI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 FRENCH RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-1054
Mailing Address - Country:US
Mailing Address - Phone:315-793-3668
Mailing Address - Fax:315-793-3691
Practice Address - Street 1:610 FRENCH RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1054
Practice Address - Country:US
Practice Address - Phone:315-793-3668
Practice Address - Fax:315-793-3691
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005470213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01979395Medicaid
NY01979395Medicaid