Provider Demographics
NPI:1679878706
Name:MANGION, JEREMY ERIC (MD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:ERIC
Last Name:MANGION
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 1:19 BRADHURST AVE
Mailing Address - Street 2:SUITE 1300N
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-789-2700
Mailing Address - Fax:
Practice Address - Street 1:200 WESTAGE BUSINESS CTR DR
Practice Address - Street 2:SUITE 115
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2264
Practice Address - Country:US
Practice Address - Phone:845-896-4178
Practice Address - Fax:845-896-4278
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI14197207X00000X
NY276704207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery