MEDICARE: EMMA A MANGOSING MD

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	208000000X	Pediatrics Physician	25MA05928600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457357196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA A MANGOSING MD

Provider Business Mailing Address
First Line	:	377 JERSEY AVE
Second Line	:	SUITE 420
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4325
Country	:	US
Telephone Number	:	201-333-0003
Fax Number	:	201-333-0006

Provider Business Practice Location Address
First Line	:	377 JERSEY AVE
Second Line	:	SUITE 420
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4325
Country	:	US
Telephone Number	:	201-333-0003
Fax Number	:	201-333-0006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	06/10/2010

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Directions to “ EMMA A MANGOSING MD” Practice Location

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