Provider Demographics
NPI:1578513214
Name:MANSUROGLU, NAIM
Entity Type:Individual
Prefix:
First Name:NAIM
Middle Name:
Last Name:MANSUROGLU
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:PO BOX 7490
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-7490
Mailing Address - Country:US
Mailing Address - Phone:718-780-5835
Mailing Address - Fax:718-780-5836
Practice Address - Street 1:506 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3609
Practice Address - Country:US
Practice Address - Phone:718-780-5835
Practice Address - Fax:718-780-5836
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230053207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00790824OtherRR MEDICARE - INTENSIVISTS
NJ0207896Medicaid
NY02589191Medicaid
NJP00790824OtherRR MEDICARE - INTENSIVISTS
NY02589191Medicaid
NJ163670ZER8Medicare PIN