Provider Demographics
NPI:1306950811
Name:MANGO, PHILIP JOHN
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOHN
Last Name:MANGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E 28TH ST
Mailing Address - Street 2:SUITE 916
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8413
Mailing Address - Country:US
Mailing Address - Phone:646-424-0395
Mailing Address - Fax:504-910-8576
Practice Address - Street 1:118 E 28TH ST
Practice Address - Street 2:SUITE 916
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8413
Practice Address - Country:US
Practice Address - Phone:646-424-0395
Practice Address - Fax:504-910-8576
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000977101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health