Provider Demographics
NPI:1750495313
Name:MCMANUS, STEPHEN WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WILLIAM
Last Name:MCMANUS
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 1:72 W JIMMIE LEEDS RD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9406
Mailing Address - Country:US
Mailing Address - Phone:609-677-9729
Mailing Address - Fax:609-652-6270
Practice Address - Street 1:2399 HIGHWAY 34
Practice Address - Street 2:UNIT B
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1500
Practice Address - Country:US
Practice Address - Phone:609-677-9729
Practice Address - Fax:609-652-6270
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA071926002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8509107Medicaid
NJP00847800OtherRAILROAD MEDICARE
NJ300122295OtherRAILROAD MEDICARE
NJP00758305OtherRAILROAD MEDICARE
NJ047844ZEKDMedicare PIN
NJ047844ZDDPMedicare PIN
NJ300122295OtherRAILROAD MEDICARE
NJP00847800OtherRAILROAD MEDICARE