MEDICARE: ANTHONY MANGIERI PA

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	363AM0700X	Medical Physician Assistant	MP000469000	NJ

General Provider Information

NPI Number	:	1881838068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY MANGIERI PA

Provider Business Mailing Address
First Line	:	297 LAFAYETTE AVE
Second Line	:
City	:	HAWTHORNE
State	:	NJ
Zip	:	07506-1919
Country	:	US
Telephone Number	:	973-423-9388
Fax Number	:	973-423-2502

Provider Business Practice Location Address
First Line	:	297 LAFAYETTE AVE
Second Line	:
City	:	HAWTHORNE
State	:	NJ
Zip	:	07506-1919
Country	:	US
Telephone Number	:	973-423-9388
Fax Number	:	973-423-2502

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

Provider Enumeration Date	:	05/01/2009
Last Update Date	:	05/01/2009

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Directions to “ ANTHONY MANGIERI PA” Practice Location

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