Provider Demographics
NPI:1235530361
Name:MANGULIS, META
Entity Type:Individual
Prefix:
First Name:META
Middle Name:
Last Name:MANGULIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 VICTORIA LN
Mailing Address - Street 2:APT J
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-2447
Mailing Address - Country:US
Mailing Address - Phone:607-427-1590
Mailing Address - Fax:
Practice Address - Street 1:10 VICTORIA LN
Practice Address - Street 2:APT J
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-2447
Practice Address - Country:US
Practice Address - Phone:607-427-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY543405163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse