Provider Demographics
NPI:1689914780
Name:RHODORA MANGASER MD LLC
Entity Type:Organization
Organization Name:RHODORA MANGASER MD LLC
Other - Org Name:RHODORA MANGASER MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RHODORA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MANGASER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-857-0002
Mailing Address - Street 1:600 SOMERDALE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1858
Mailing Address - Country:US
Mailing Address - Phone:856-857-0002
Mailing Address - Fax:856-857-0040
Practice Address - Street 1:600 SOMERDALE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1858
Practice Address - Country:US
Practice Address - Phone:856-857-0002
Practice Address - Fax:856-857-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04576300261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2218607Medicaid
NJ2218607Medicaid