Provider Demographics
NPI:1033196670
Name:MANGEL, WARREN BRUCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:BRUCE
Last Name:MANGEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CRAWFORD PL STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3954
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:805 COOPER RD STE 4
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3814
Practice Address - Country:US
Practice Address - Phone:856-479-9430
Practice Address - Fax:856-281-9102
Is Sole Proprietor?:No
Enumeration Date:2005-12-25
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00145500213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3190200Medicaid
NJ7580240001Medicare NSC
NJT44782Medicare UPIN
NJ3190200Medicaid
NJ3190200Medicaid
NJ381020OtherMEDICARE GROUP