Thomas J Mango MD PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

210442 Issued in NY

Legal business name

THOMAS J MANGO MD PC

Practice address

31 Oak St
Suite 3
Patchogue, NY 11772-2887

Phone

(631) 758-3911

Fax

(631) 758-4072

NPI assigned

Apr 6, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Gina Bancroft

Title

Manager

Phone

(631) 758-3911

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609838259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 OAK ST",
            "address_2": "SUITE 3",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117722887",
            "telephone_number": "631-758-3911",
            "fax_number": "631-758-4072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 OAK ST",
            "address_2": "SUITE 3",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117722887",
            "telephone_number": "631-758-3911",
            "fax_number": "631-758-4072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS J MANGO MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BANCROFT",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "631-758-3911",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "210442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Patchogue, NY
• Providers in Patchogue, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.