Provider Demographics
NPI:1881838068
Name:MANGIERI, ANTHONY (PA)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:MANGIERI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-1919
Mailing Address - Country:US
Mailing Address - Phone:973-423-9388
Mailing Address - Fax:973-423-2502
Practice Address - Street 1:297 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-1919
Practice Address - Country:US
Practice Address - Phone:973-423-9388
Practice Address - Fax:973-423-2502
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP000469000363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical