1447216924 NPI number — DR. ANTHONY R MANGANO MD

Table of content: DR. ANTHONY R MANGANO MD (NPI 1447216924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447216924 NPI number — DR. ANTHONY R MANGANO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANGANO
Provider First Name:
ANTHONY
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447216924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9521 MALLORY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HARTFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13413-3819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-725-5140
Provider Business Mailing Address Fax Number:
317-922-7012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9521 MALLORY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HARTFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13413-3819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-725-5140
Provider Business Practice Location Address Fax Number:
315-922-7012
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  226173 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00026269101 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: BM7996599 . This is a "DEA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010226172 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0140611 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1611616 . This is a "INDEPENDENT HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4105275 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040426003192 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000527299005 . This is a "BLUE SHIELD WNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02389215 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2261733W . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00029523 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P020226173 . This is a "BLUE SHIED ROCHESTER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 197608FF . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00131609 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00026269103 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000527299001 . This is a "BLUE SHIELD WNY" identifier . This identifiers is of the category "OTHER".




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