Provider Demographics
NPI:1508100322
Name:MANGCOY, BOBBY SADIUA (PT)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:SADIUA
Last Name:MANGCOY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WEST 86 STREET CENTRAL PARK WEST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-787-7994
Mailing Address - Fax:212-595-4716
Practice Address - Street 1:2 WEST 86 STREET CENTRAL PARK WEST
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-787-7994
Practice Address - Fax:212-595-4716
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026088-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist