Provider Demographics
NPI:1043279193
Name:MANGRU, SUBITA S (MD)
Entity type:Individual
Prefix:DR
First Name:SUBITA
Middle Name:S
Last Name:MANGRU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:159 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1849
Mailing Address - Country:US
Mailing Address - Phone:973-912-0155
Mailing Address - Fax:973-912-8714
Practice Address - Street 1:159 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1849
Practice Address - Country:US
Practice Address - Phone:973-912-0155
Practice Address - Fax:973-912-8714
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA064575002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine