Provider Demographics
NPI:1235639394
Name:FARAG A MANKARIOS MD LLC
Entity Type:Organization
Organization Name:FARAG A MANKARIOS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANKARIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-863-5515
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-0032
Mailing Address - Country:US
Mailing Address - Phone:732-863-5515
Mailing Address - Fax:
Practice Address - Street 1:410 ROUTE 34 STE 216
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2519
Practice Address - Country:US
Practice Address - Phone:732-863-5515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07048000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty