Healthcare Provider Details

I. General information

NPI: 1609118710
Provider Name (Legal Business Name): MATTHEW STEPHEN MANGANARO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 10TH AVE
BROOKLYN NY
11219-2916
US

IV. Provider business mailing address

5402 FORT HAMILTON PKWY FL 6
BROOKLYN NY
11219
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-9055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number65173
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number339293
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: