Provider Demographics
NPI:1063560522
Name:WARREN B. MANGEL, DPM
Entity type:Organization
Organization Name:WARREN B. MANGEL, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-963-0190
Mailing Address - Street 1:6650 BROWNING RD
Mailing Address - Street 2:SUITE M20
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-1479
Mailing Address - Country:US
Mailing Address - Phone:856-963-0190
Mailing Address - Fax:856-963-5100
Practice Address - Street 1:6650 BROWNING RD
Practice Address - Street 2:SUITE M20
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-1479
Practice Address - Country:US
Practice Address - Phone:856-963-0190
Practice Address - Fax:856-963-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00145500213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3190200Medicaid
NJ0084242000OtherAMERIHEALTH
NJ0084242000OtherKEYSTONE
NJ480004285OtherMEDICARE RRB
NJ149526Medicare PIN
NJ0084242000OtherAMERIHEALTH
NJ480004285OtherMEDICARE RRB