Provider Demographics
NPI:1619942000
Name:LAMENDOLA, JASON P
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:P
Last Name:LAMENDOLA
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 1:1100 CLOVE RD
Mailing Address - Street 2:SUITE GC
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3648
Mailing Address - Country:US
Mailing Address - Phone:718-816-5000
Mailing Address - Fax:718-816-4677
Practice Address - Street 1:1100 CLOVE RD
Practice Address - Street 2:SUITE GC
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3648
Practice Address - Country:US
Practice Address - Phone:718-816-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0205341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY206Q01Medicare ID - Type Unspecified
NYQ06078Medicare UPIN