Provider Demographics
NPI:1144901893
Name:NEUROINTERVENTIONAL MEDICINE PLLC
Entity type:Organization
Organization Name:NEUROINTERVENTIONAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-575-7703
Mailing Address - Street 1:8 THOMAS ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-1139
Mailing Address - Country:US
Mailing Address - Phone:917-575-7703
Mailing Address - Fax:516-266-6314
Practice Address - Street 1:6702 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5203
Practice Address - Country:US
Practice Address - Phone:516-266-6499
Practice Address - Fax:516-266-6314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty