Provider Demographics
NPI:1841592946
Name:DR. MARIO J. MANNA MEDICAL PC
Entity Type:Organization
Organization Name:DR. MARIO J. MANNA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:646-576-5700
Mailing Address - Street 1:7318 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2011
Mailing Address - Country:US
Mailing Address - Phone:718-630-1404
Mailing Address - Fax:
Practice Address - Street 1:7318 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2011
Practice Address - Country:US
Practice Address - Phone:718-630-1404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty