Provider Demographics
NPI:1437102266
Name:MANGAN, DEBORAH ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:MANGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1536 3RD AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2167
Mailing Address - Country:US
Mailing Address - Phone:212-861-2630
Mailing Address - Fax:212-861-2685
Practice Address - Street 1:141 S CENTRAL AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-2319
Practice Address - Country:US
Practice Address - Phone:914-946-5685
Practice Address - Fax:914-946-0304
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY021841-1225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ93F51Medicare PIN