Provider Demographics
NPI:1497830277
Name:MANTIA, PAUL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAMES
Last Name:MANTIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:45 E END AVE
Mailing Address - Street 2:APT 7C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7953
Mailing Address - Country:US
Mailing Address - Phone:212-288-8786
Mailing Address - Fax:
Practice Address - Street 1:9411 59TH AVE
Practice Address - Street 2:APT A10
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5101
Practice Address - Country:US
Practice Address - Phone:718-651-2002
Practice Address - Fax:718-651-2262
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY178931207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01355471Medicaid
NY01355471Medicaid
F20954Medicare UPIN