| Doctor Name: | MARY MANGO |
| NPI Number: | 1043330236 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ANP |
| License Number: | F304256-1 |
| Business Practice Address: | 220 N Belle Mead Rd Ste A East Setauket, NY - 117333458 |
| Business Phone Number: | 6319412273 |
| Business Fax Number: | 6319413090 |
| Mailing Address: | 194 Pond View Ln, SMITHTOWN |
| State: | NY |
| Postal Code: | 117875200 |
| Phone Number: | 6312911876 |
| Fax Number: | |
| NPI Enumeration Date: | 03/30/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | F304256-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |