Provider Demographics
NPI:1659357721
Name:MANGLA, SUNDEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNDEEP
Middle Name:
Last Name:MANGLA
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 1:8 THOMAS ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-1139
Mailing Address - Country:US
Mailing Address - Phone:917-575-7703
Mailing Address - Fax:516-266-6314
Practice Address - Street 1:6702 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5203
Practice Address - Country:US
Practice Address - Phone:516-266-6499
Practice Address - Fax:516-266-6314
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219126-12085R0202X
NY2191262085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02086102Medicaid
NYG76726Medicare UPIN
NY977641Medicare ID - Type Unspecified