Provider Demographics
NPI:1841592938
Name:MANGINO, MICHAEL (CPO, CPED)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MANGINO
Suffix:
Gender:M
Credentials:CPO, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BEAUMONT DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3402
Mailing Address - Country:US
Mailing Address - Phone:631-271-0825
Mailing Address - Fax:
Practice Address - Street 1:616 E JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-7317
Practice Address - Country:US
Practice Address - Phone:631-271-0825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist