Provider Demographics
NPI:1164718722
Name:MANGALAT, NEAL MOHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:MOHEN
Last Name:MANGALAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 COOK AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2912
Mailing Address - Country:US
Mailing Address - Phone:321-841-2605
Mailing Address - Fax:
Practice Address - Street 1:1720 COOK AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2912
Practice Address - Country:US
Practice Address - Phone:321-841-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFM4583173207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine