Mangru, Vadewattie

Mangru, Vadewattie is an individual health care provider with primary practice located at 82-68 164Th St , Jamaica NY 11432-1121. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Primary Care, which is considered as her primary health care specialty. Mangru, Vadewattie can be contacted via phone (718) 883-3225.

Contact Information

Primary practice address
82-68 164Th St Jamaica NY 11432-1121
Phone: (718) 883-3225
Fax: (718) 883-6193
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X F331468 New York

Profile Details

NPI number 1467546317
LBN Legal business name Mangru, Vadewattie
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 3rd, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1467546317 NPPES
New York MEDICAID 00246075

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