Individual
MR. MICHAEL WILLIAM MANGINO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP-P
Contact information
Practice address
533 COLLEGE RD, RIVERHEAD BUILDING, SELDEN, NY 11784-2851
(631) 473-2453
Mailing address
533 COLLEGE RD, RIVERHEAD BUILDING, SELDEN, NY 11784-2851
(631) 473-2453
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
400716
NY
Other
Enumeration date
08/20/2013
Last updated
08/20/2013
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