Provider Demographics
NPI:1437361201
Name:MANGIERI,JR., ROBERT L (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:MANGIERI,JR.
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2062 CENTRAL PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710
Mailing Address - Country:US
Mailing Address - Phone:914-961-1313
Mailing Address - Fax:914-793-8515
Practice Address - Street 1:2062 CENTRAL PARK AVENUE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710
Practice Address - Country:US
Practice Address - Phone:914-961-1313
Practice Address - Fax:914-793-8515
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX002800OtherSTATE LICENSE NUMBER
NYT512193Medicare UPIN
NYX15681Medicare ID - Type Unspecified