Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X006410 | NY |
NPI | 1598714768 |
---|---|
Provider Name | Dr. Ralph Mangels |
First Address | Bay Shore, NY 11706-8403 |
Second Address | Bay Shore, NY 11706-8403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AA71544 | MDNY (01) | NY |
P1950185 | OXFORD (01) | NY |
U79893 | (02) | NY |