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General NPI Number Information
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NPI Number | 1912566787
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Entity Type | Individual
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Provider Name | MANISHA MANGLA
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Gender | Female
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Dates
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Enumeration Date | 06/06/2019
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 750 E ADAMS ST
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City | SYRACUSE
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State | NY
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Zip | 13210-1834
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Country | US
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Telephone | 315-464-7494
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Fax | 315-464-5189
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Provider Business Mailing Address
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Address Line | 224 HARRISON ST STE 601
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City | SYRACUSE
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State | NY
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Zip | 13202-3186
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Country | US
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Telephone | 315-464-5660
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Fax | 315-464-7695
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 334749
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 334749
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License Number State | NY
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