Provider Demographics
NPI:1841818440
Name:MANGRU, MARIA (DPT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MANGRU
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CARROLL CT
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1706
Mailing Address - Country:US
Mailing Address - Phone:862-812-8676
Mailing Address - Fax:
Practice Address - Street 1:8 TOWN CENTER DR STE 1
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1989
Practice Address - Country:US
Practice Address - Phone:973-726-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01927400261QP2000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01927400OtherNJ STATE BOARD OF PT EXAMINERS