Individual
MARY MANGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
220 N BELLE MEAD RD STE A, EAST SETAUKET, NY 11733-3458
(631) 941-2273
(631) 941-3090
Mailing address
194 POND VIEW LN, SMITHTOWN, NY 11787-5200
(631) 291-1876
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F304256-1
NY
Other
Enumeration date
03/30/2007
Last updated
07/08/2007
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