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General NPI Number Information
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NPI Number | 1356330773
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Entity Type | Individual
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Provider Name | VIRGILIO MANGONON M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 02/15/2011
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Provider Practice Location Address
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Address Line | 525 JACK MARTIN BLVD SUITE 300
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City | BRICK
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State | NJ
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Zip | 08724-7737
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Country | US
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Telephone | 732-840-0067
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Fax |
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Provider Business Mailing Address
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Address Line | 138 W 56TH ST
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City | BAYONNE
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State | NJ
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Zip | 07002-2210
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Country | US
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Telephone | 201-487-7227
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MA39916
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License Number State | NJ
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