Angela Manjgaladze

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

402705 Issued in NY

Practice address

600 Fishers Station Dr Ste 117
Victor, NY 14564-9784

Phone

(585) 337-0992

Fax

(585) 337-0998

NPI assigned

Feb 12, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675209600000",
    "number": "1194281444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 FISHERS STATION DR STE 117",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145649784",
            "telephone_number": "585-337-0992",
            "fax_number": "585-337-0998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 FISHERS STATION DR STE 117",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145649784",
            "telephone_number": "585-337-0992",
            "fax_number": "585-337-0998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANJGALADZE",
        "first_name": "ANGELA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-12",
        "last_updated": "2023-02-01",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "001782",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "402705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Betty Maclean, MS.ED
• Gina Marie Mahar, M.S., ED.
• Joan Maher
• Mya Mahon, MS
• Melissa Maloney, SLP
• Leah M. Mannion, M.A.
• Lauren Manns
• Katherine Manser, SLP
• Rene' Ann Marburger, M.ED
• Norene Marlowe

• Psychiatric/Mental Health Nurse Practitioner in Victor, NY
• Providers in Victor, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.