Provider Demographics
NPI:1720244312
Name:MANGAN, CYNTHIA ANNE (MA, PT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANNE
Last Name:MANGAN
Suffix:
Gender:F
Credentials:MA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 BEA CT
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5907
Mailing Address - Country:US
Mailing Address - Phone:516-317-9375
Mailing Address - Fax:516-764-5323
Practice Address - Street 1:3941 BEA CT
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5907
Practice Address - Country:US
Practice Address - Phone:516-317-9375
Practice Address - Fax:516-764-5323
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-02
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY014987-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist