Healthcare Provider Details

I. General information

NPI: 1427094309
Provider Name (Legal Business Name): NORA RAMOS MANGUNAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 PROSPECT STREET
SUMMIT NJ
07901
US

IV. Provider business mailing address

19 PROSPECT STREET
SUMMIT NJ
07901
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-7000
  • Fax: 908-522-7098
Mailing address:
  • Phone: 908-522-7000
  • Fax: 908-522-7098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA04697700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: