Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 059291-1 | NY |
NPI | 1073031506 |
---|---|
Provider Name | Dr. Rhugielyn Mangaoang |
First Address | New York, NY 10019-1918 |
Second Address | New York, NY 10019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2017 |
Last Update Date | 06/06/2018 |