MEDICARE: MR. PHILIP J BANGURA M.ED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		PA

General Provider Information

NPI Number	:	1184551202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILIP J BANGURA M.ED

Provider Business Mailing Address
First Line	:	6630 LEEDS ST APT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-3028
Country	:	US
Telephone Number	:	484-841-3426
Fax Number	:	484-841-3426

Provider Business Practice Location Address
First Line	:	6630 LEEDS ST APT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-3028
Country	:	US
Telephone Number	:	484-841-3426
Fax Number	:	484-841-3426

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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