Provider Demographics
NPI:1750785416
Name:POMPONIO- CARECCIA, JOHN J (ATC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:POMPONIO- CARECCIA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:497 MEDINA ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4452
Mailing Address - Country:US
Mailing Address - Phone:718-836-9800
Mailing Address - Fax:718-748-5436
Practice Address - Street 1:9216 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3622
Practice Address - Country:US
Practice Address - Phone:718-836-9800
Practice Address - Fax:718-748-5436
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001484-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer