1497825053 NPI number — MANFREDI SURGICAL & ORTHOPEDIC CO., INC.

Table of content: (NPI 1497825053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497825053 NPI number — MANFREDI SURGICAL & ORTHOPEDIC CO., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANFREDI SURGICAL & ORTHOPEDIC CO., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MANFREDI ORTHOTIC & PROSTHETIC AFFILIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497825053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 HOOPER AVE STE 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08753-7672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-244-1952
Provider Business Mailing Address Fax Number:
732-244-1953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 HOOPER AVE STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08753-7672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-244-1952
Provider Business Practice Location Address Fax Number:
732-380-0245
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MANFREDI
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
732-222-0366

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  45PO00001100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2641607 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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