Provider Demographics
NPI:1134143035
Name:MANGLA, ARUN K (MD)
Entity type:Individual
Prefix:DR
First Name:ARUN
Middle Name:K
Last Name:MANGLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8548 112TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1641
Mailing Address - Country:US
Mailing Address - Phone:718-847-5059
Mailing Address - Fax:718-441-5903
Practice Address - Street 1:8548 112TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1641
Practice Address - Country:US
Practice Address - Phone:718-847-5059
Practice Address - Fax:718-441-5903
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160996207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY75185Medicare ID - Type Unspecified