Healthcare Provider Details

I. General information

NPI: 1124141304
Provider Name (Legal Business Name): MONIKA WYGANOWSKA MANSMANN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONIKA WYGANOWSKA PA-C

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 HERITAGE CENTER DR STE 317
FURLONG PA
18925-1262
US

IV. Provider business mailing address

2325 HERITAGE CENTER DR STE 317
FURLONG PA
18925-1262
US

V. Phone/Fax

Practice location:
  • Phone: 215-874-4200
  • Fax: 215-918-8808
Mailing address:
  • Phone: 215-874-4200
  • Fax: 215-918-8808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMA062453
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: