Provider Demographics
NPI:1396354916
Name:MALANGONE, BIANCA M
Entity type:Individual
Prefix:MS
First Name:BIANCA
Middle Name:M
Last Name:MALANGONE
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 1:167 S EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-3041
Mailing Address - Country:US
Mailing Address - Phone:631-513-9559
Mailing Address - Fax:
Practice Address - Street 1:15 ECHO AVE
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-2000
Practice Address - Country:US
Practice Address - Phone:631-476-4855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025865225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist