Provider Demographics
NPI:1851410708
Name:MANGINI, BRIAN (CMMT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MANGINI
Suffix:
Gender:M
Credentials:CMMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 MARLTON PIKE E
Mailing Address - Street 2:VILLAGE WALK PLAZA STE 5
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1836
Mailing Address - Country:US
Mailing Address - Phone:609-868-9443
Mailing Address - Fax:
Practice Address - Street 1:1990 MARLTON PIKE E
Practice Address - Street 2:VILLAGE WALK PLAZA STE 5
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1836
Practice Address - Country:US
Practice Address - Phone:609-868-9443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath