Provider Demographics
NPI:1063051241
Name:MONROYO, JOSE DONALD MENDEJA
Entity type:Individual
Prefix:MR
First Name:JOSE DONALD
Middle Name:MENDEJA
Last Name:MONROYO
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 1:14712 17TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2515
Mailing Address - Country:US
Mailing Address - Phone:718-461-2297
Mailing Address - Fax:
Practice Address - Street 1:2100 BARTOW AVE RM 227
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4614
Practice Address - Country:US
Practice Address - Phone:718-320-9000
Practice Address - Fax:718-320-9380
Is Sole Proprietor?:No
Enumeration Date:2020-01-05
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032423-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist