Provider Demographics
NPI:1497825053
Name:MANFREDI SURGICAL & ORTHOPEDIC CO., INC.
Entity Type:Organization
Organization Name:MANFREDI SURGICAL & ORTHOPEDIC CO., INC.
Other - Org Name:MANFREDI ORTHOTIC & PROSTHETIC AFFILIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANFREDI
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:732-222-0366
Mailing Address - Street 1:201 HOOPER AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7672
Mailing Address - Country:US
Mailing Address - Phone:732-244-1952
Mailing Address - Fax:732-244-1953
Practice Address - Street 1:201 HOOPER AVE STE 6
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7672
Practice Address - Country:US
Practice Address - Phone:732-244-1952
Practice Address - Fax:732-380-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00001100335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2641607Medicaid