Individual
DR. SIMARDEEP MANGAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1304 BUCKLEY RD, SYRACUSE, NY 13212-4311
(315) 478-3311
(315) 426-0796
Mailing address
1304 BUCKLEY ROAD, SYRACUSE, NY 13212
(315) 478-3311
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
235907
NY
207RN0300X
Nephrology Physician
Primary
235907
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02969271
—
NY
01
—
204496170
EXCELLUS
NY
Enumeration date
09/16/2006
Last updated
05/18/2012
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