Provider Demographics
NPI:1669206629
Name:MANGAL, PUNEET
Entity type:Individual
Prefix:
First Name:PUNEET
Middle Name:
Last Name:MANGAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ALBION RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-3749
Mailing Address - Country:US
Mailing Address - Phone:401-321-4518
Mailing Address - Fax:
Practice Address - Street 1:1 ALBION RD STE 105
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-3749
Practice Address - Country:US
Practice Address - Phone:401-321-4518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2344215163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse