Healthcare Provider Details

I. General information

NPI: 1023570157
Provider Name (Legal Business Name): BERNADITA A MANGLONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2019
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 MALCOLM X BLVD
NEW YORK NY
10027-5755
US

IV. Provider business mailing address

241 MALCOLM X BLVD
NEW YORK NY
10027-5755
US

V. Phone/Fax

Practice location:
  • Phone: 646-435-6553
  • Fax:
Mailing address:
  • Phone: 646-435-6553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number061392
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: