Provider Demographics
NPI:1679816326
Name:MANTOPOULOS, DIMOSTHENIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DIMOSTHENIS
Middle Name:
Last Name:MANTOPOULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MOUNTAIN AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-2736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:732-220-1603
Practice Address - Street 1:10 PLUM ST STE 600
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2065
Practice Address - Country:US
Practice Address - Phone:732-220-1600
Practice Address - Fax:732-220-1603
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09867700207W00000X
NH18744207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology