Healthcare Provider Details

I. General information

NPI: 1861194102
Provider Name (Legal Business Name): MAHIMA MANGLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E 77TH ST FL 6
NEW YORK NY
10075-1851
US

IV. Provider business mailing address

130 E 77TH ST FL 6
NEW YORK NY
10075-1851
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-4763
  • Fax:
Mailing address:
  • Phone: 212-434-4763
  • 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: