Provider Demographics
NPI:1750320040
Name:MANGIA, ANTHONY J (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:MANGIA
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 1:239 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3828
Mailing Address - Country:US
Mailing Address - Phone:201-521-1100
Mailing Address - Fax:201-521-1236
Practice Address - Street 1:239 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3828
Practice Address - Country:US
Practice Address - Phone:201-521-1100
Practice Address - Fax:201-521-1236
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25A04822500207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0882305Medicaid
NJ0882305Medicaid
NJE23749Medicare UPIN