Provider Demographics
NPI:1952329484
Name:MANGIONE, MATTHEW F (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:F
Last Name:MANGIONE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HEMPSTEAD AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:126 E MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2600
Practice Address - Country:US
Practice Address - Phone:516-536-7388
Practice Address - Fax:888-215-5118
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQN7661Medicare Oscar/Certification
NYQN7661Medicare PIN