Healthcare Provider Details

I. General information

NPI: 1699841627
Provider Name (Legal Business Name): CHRISTINA MANGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 E 188TH ST, FORDHAM-TREMONT
BRONX NY
10457
US

IV. Provider business mailing address

234 GARFIELD ST
HAWORTH NJ
07641-1420
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-0469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number000063
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: