Individual
ANGELINA MAMANOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17408 73RD AVE, FRESH MEADOWS, NY 11366-1404
(646) 233-9405
Mailing address
17408 73RD AVE, FRESH MEADOWS, NY 11366-1404
(646) 233-9405
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
017684
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017864
—
NY
Enumeration date
08/11/2014
Last updated
08/11/2014
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