Provider Demographics
NPI:1861659823
Name:MANGIAMELI, DAVID P (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:MANGIAMELI
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 1:100 HOSPITAL RD STE 201
Mailing Address - Street 2:ATTN- LIZ KNUERR
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-8814
Mailing Address - Country:US
Mailing Address - Phone:631-687-4237
Mailing Address - Fax:631-447-3012
Practice Address - Street 1:100 HOSPITAL RD STE 201
Practice Address - Street 2:ATTN: LIZ KNUERR
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-8814
Practice Address - Country:US
Practice Address - Phone:631-687-4237
Practice Address - Fax:631-447-3012
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY247678208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02977484Medicaid
NY3RR18WR581Medicare PIN