Provider Demographics
NPI:1679064000
Name:MANGAT, JODHVIR SINGH (MD)
Entity type:Individual
Prefix:DR
First Name:JODHVIR
Middle Name:SINGH
Last Name:MANGAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LOGANS WAY
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-3402
Mailing Address - Country:US
Mailing Address - Phone:845-702-5896
Mailing Address - Fax:
Practice Address - Street 1:52 E ROUTE 59
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2903
Practice Address - Country:US
Practice Address - Phone:845-215-9661
Practice Address - Fax:845-215-9162
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY327667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program