Provider Demographics
NPI:1184831844
Name:MANGASER, ANACLETO JR APOSTOL (MD)
Entity Type:Individual
Prefix:
First Name:ANACLETO JR
Middle Name:APOSTOL
Last Name:MANGASER
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 1:1176 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3440
Mailing Address - Country:US
Mailing Address - Phone:716-689-4946
Mailing Address - Fax:
Practice Address - Street 1:1 SHERIDAN DRIVE
Practice Address - Street 2:DUPONT YERKES MEDICAL DEPT
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207
Practice Address - Country:US
Practice Address - Phone:716-879-4523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1362402083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS-136240OtherWORKER'S COMP