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General NPI Number Information
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NPI Number | 1871540484
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Entity Type | Individual
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Provider Name | MELVIN SERRANO MANGULABNAN MD
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Gender | Male
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 03/01/2010
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Provider Practice Location Address
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Address Line | 3918 SENECA ST
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City | WEST SENECA
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State | NY
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Zip | 14224-3411
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Country | US
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Telephone | 716-675-4433
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Fax | 716-675-5212
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Provider Business Mailing Address
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Address Line | 29 DEER RUN
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City | ORCHARD PARK
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State | NY
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Zip | 14127-3455
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Country | US
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Telephone | 716-667-3492
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 189425
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License Number State | NY
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