Provider Demographics
NPI:1770966640
Name:MENDOLA, JONATHON (DPT)
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:
Last Name:MENDOLA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 POST RD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 RIVER RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2759
Practice Address - Country:US
Practice Address - Phone:203-202-2703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038813-1208100000X
CT14.011135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist