Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 023165-1 | NY |
NPI | 1326605833 |
---|---|
Provider Name | Vincenzo Mangione |
First Address | Franklin Square, NY 11010-1703 |
Second Address | Long Island City, NY 11101-4020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2019 |
Last Update Date | 21/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1158966 | NCCPA # (01) |