Provider Demographics
NPI:1154300317
Name:MANNO, EUGENE M (DPM)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:M
Last Name:MANNO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 NORTH AVE
Mailing Address - Street 2:15V
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2404
Mailing Address - Country:US
Mailing Address - Phone:201-783-2618
Mailing Address - Fax:
Practice Address - Street 1:1685 NEWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1603
Practice Address - Country:US
Practice Address - Phone:516-828-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00113300213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA532948Medicare ID - Type Unspecified
NJT44936Medicare UPIN