Provider Demographics
NPI:1720217672
Name:MANGANARO, SUSAN NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:NICOLE
Last Name:MANGANARO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:NEUROLOGY ASSOCIATES OF STONY BROOK UFPC
Mailing Address - Street 2:STONY BROOK UNIVERSITY HOSPITAL, HSC T12-020
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8121
Mailing Address - Country:US
Mailing Address - Phone:631-444-2599
Mailing Address - Fax:631-444-1474
Practice Address - Street 1:NEUROLOGY ASSOCIATES OF STONY BROOK UFPC
Practice Address - Street 2:STONY BROOK UNIVERSITY HOSPITAL, HSC T12-020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8121
Practice Address - Country:US
Practice Address - Phone:631-444-2599
Practice Address - Fax:631-444-1474
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2016-04-22
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Provider Licenses
StateLicense IDTaxonomies
NY2745052084S0012X, 2084N0600X, 2084N0402X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology