Provider Demographics
NPI:1376615435
Name:MANCINE, CLIFFORD G
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:G
Last Name:MANCINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 ROUTE 130
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-2522
Mailing Address - Country:US
Mailing Address - Phone:856-764-0200
Mailing Address - Fax:856-764-1414
Practice Address - Street 1:2910 ROUTE 130
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-2522
Practice Address - Country:US
Practice Address - Phone:856-764-0200
Practice Address - Fax:856-764-1414
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ1048156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0671790001Medicare ID - Type Unspecified