Healthcare Provider Details

I. General information

NPI: 1770420176
Provider Name (Legal Business Name): TACHEI MANGOL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OLD COUNTRY RD STE 460
MINEOLA NY
11501-4293
US

IV. Provider business mailing address

12030 231ST ST
CAMBRIA HEIGHTS NY
11411-2220
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-2752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: