Healthcare Provider Details

I. General information

NPI: 1235048349
Provider Name (Legal Business Name): MR. ANTHONY MANGO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 HUGUENOT ST
NEW ROCHELLE NY
10801-5204
US

IV. Provider business mailing address

150 HUGUENOT ST
NEW ROCHELLE NY
10801-5204
US

V. Phone/Fax

Practice location:
  • Phone: 914-613-0700
  • Fax:
Mailing address:
  • Phone: 914-613-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: