Healthcare Provider Details

I. General information

NPI: 1912309733
Provider Name (Legal Business Name): MS. EMILY MANGANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 MERRICK RD
BELLMORE NY
11710-5730
US

IV. Provider business mailing address

620 MADISON AVE
LINDENHURST NY
11757-5837
US

V. Phone/Fax

Practice location:
  • Phone: 516-590-7575
  • Fax: 516-590-7573
Mailing address:
  • Phone: 631-882-1295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: