Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 25MD00145500 | NJ |
N | 222Z00000X | Podiatrist | 25MD00145500 | NJ |
Y | 213ES0103X | Foot & Ankle Surgery | 25MD00145500 | NJ |
NPI | 1033196670 |
---|---|
Provider Name | Dr. Warren Bruce Mangel |
First Address | Mount Laurel, NJ 08054-3954 |
Second Address | Voorhees, NJ 08043-3814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/12/2005 |
Last Update Date | 21/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3190200 | (05) | NJ |
T44782 | (02) | NJ |