Provider Demographics
NPI:1790818136
Name:MANGIOLINO, VINCENZA (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:VINCENZA
Middle Name:
Last Name:MANGIOLINO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 SUFFOLK AVE
Mailing Address - Street 2:STE 208
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4305
Mailing Address - Country:US
Mailing Address - Phone:631-231-3535
Mailing Address - Fax:631-231-3535
Practice Address - Street 1:225 CENTRAL AVE S
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-4940
Practice Address - Country:US
Practice Address - Phone:516-293-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008396363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical