MEDICARE: NEUROINTERVENTIONAL MEDICINE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085N0700X	Neuroradiology Physician

General Provider Information

NPI Number	:	1144901893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROINTERVENTIONAL MEDICINE PLLC

Provider Business Mailing Address
First Line	:	8 THOMAS ST APT 3
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10007-1139
Country	:	US
Telephone Number	:	917-575-7703
Fax Number	:	516-266-6314

Provider Business Practice Location Address
First Line	:	6702 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-5203
Country	:	US
Telephone Number	:	516-266-6499
Fax Number	:	516-266-6314

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SUNDEEP MANGLA
Credential	:	MD
Telephone Number	:	917-575-7703

Provider Enumeration Date	:	07/26/2023
Last Update Date	:	08/22/2023

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