IndividualActive
Russell Mongiovi, DPM
NPI 1104852136 · Sports Medicine Podiatrist · Malta, NY
Provider details
- NPI number
- 1104852136
- Entity type
- Individual
- Primary specialty
- Sports Medicine PodiatristPodiatric Medicine & Surgery Service Providers
- Credential
- DPM
- Sex
- Male
- Sole proprietor
- No
- License
- N004782 (NY)
Practice location
3 Hemphill Pl
Malta, NY 12020-4419
Phone: (518) 899-3338
Fax: (518) 899-5025
Mailing address
3 Hemphill Pl
Malta, NY 12020-4420
Registry dates
- Enumerated
- 2006-06-23
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.