Provider Demographics
NPI:1053364364
Name:MANGINELLO, FRANK P (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:P
Last Name:MANGINELLO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-3303
Mailing Address - Country:US
Mailing Address - Phone:201-236-3090
Mailing Address - Fax:
Practice Address - Street 1:223 N VAN DIEN AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2726
Practice Address - Country:US
Practice Address - Phone:201-447-8388
Practice Address - Fax:201-447-8616
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA033134002080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1423908Medicaid
NJ1423908Medicaid