Provider Demographics
NPI:1184665432
Name:MANGANELLI, DOUGLAS M (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:M
Last Name:MANGANELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 ROUTE 35
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-2765
Mailing Address - Country:US
Mailing Address - Phone:732-275-7779
Mailing Address - Fax:732-660-1998
Practice Address - Street 1:1907 ROUTE 35
Practice Address - Street 2:SUITE 2
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2765
Practice Address - Country:US
Practice Address - Phone:732-275-7779
Practice Address - Fax:732-660-1998
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA53302207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5368405Medicaid
NJF36368Medicare UPIN
NJ5368405Medicaid