Healthcare Provider Details

I. General information

NPI: 1043598030
Provider Name (Legal Business Name): MARY E MANGANARO P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH ST # C3
BUFFALO NY
14203-1126
US

IV. Provider business mailing address

100 HIGH ST # C3
BUFFALO NY
14203-1126
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-7600
  • Fax: 716-859-2885
Mailing address:
  • Phone: 716-859-7600
  • Fax: 716-859-2885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number015920-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: