Provider Demographics
NPI:1902317225
Name:MANGANO, MARINA (DC)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:MANGANO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9505 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:STONE HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08247-1928
Mailing Address - Country:US
Mailing Address - Phone:609-425-5446
Mailing Address - Fax:
Practice Address - Street 1:9505 3RD AVE
Practice Address - Street 2:
Practice Address - City:STONE HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08247-1928
Practice Address - Country:US
Practice Address - Phone:609-600-7292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00772100111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1902317225OtherNPI NUMBER