Provider Demographics
NPI:1144035023
Name:MANGONA, LEIGH ANNE R
Entity type:Individual
Prefix:
First Name:LEIGH ANNE
Middle Name:R
Last Name:MANGONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MAIN ST STE 505
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3903
Mailing Address - Country:US
Mailing Address - Phone:732-493-3100
Mailing Address - Fax:
Practice Address - Street 1:903 NJ ROUTE 10
Practice Address - Street 2:
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981
Practice Address - Country:US
Practice Address - Phone:973-929-2729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00405700225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant