Provider Demographics
NPI:1063449767
Name:AMENDO, MANUEL T (MD FACC)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:T
Last Name:AMENDO
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1564
Mailing Address - Country:US
Mailing Address - Phone:609-655-3800
Mailing Address - Fax:609-655-5203
Practice Address - Street 1:11 CENTRE DR
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-1564
Practice Address - Country:US
Practice Address - Phone:609-655-3800
Practice Address - Fax:609-655-5203
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02798100207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1854801Medicaid
NJ1854801Medicaid
NJC53317Medicare UPIN