Provider Demographics
NPI:1750643284
Name:MANGIACOTTI, IRENE (MSED)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:MANGIACOTTI
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 VALLEYVIEW RD
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-1847
Mailing Address - Country:US
Mailing Address - Phone:914-591-4670
Mailing Address - Fax:
Practice Address - Street 1:117 VALLEYVIEW RD
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-1847
Practice Address - Country:US
Practice Address - Phone:914-591-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141656021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist