1710695044 NPI number — HAPPY MANGO MENTAL HEALTH PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710695044 NPI number — HAPPY MANGO MENTAL HEALTH PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAPPY MANGO MENTAL HEALTH PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1710695044
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
286 OLD SOMERSET RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATCHUNG
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07069-6056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-459-9264
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 MADISON AVE STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07960-7366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-490-4284
Provider Business Practice Location Address Fax Number:
973-363-9616
Provider Enumeration Date:
11/07/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WONG
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
212-459-9264

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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