Provider Demographics
NPI:1881628881
Name:MANNA, BIAGIO (DO)
Entity Type:Individual
Prefix:
First Name:BIAGIO
Middle Name:
Last Name:MANNA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 FULD STREET
Mailing Address - Street 2:SUITE 403
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638
Mailing Address - Country:US
Mailing Address - Phone:609-656-8622
Mailing Address - Fax:609-656-8626
Practice Address - Street 1:40 FULD STREET
Practice Address - Street 2:SUITE 403
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638
Practice Address - Country:US
Practice Address - Phone:609-656-8622
Practice Address - Fax:609-656-8626
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06598500208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
2K2657OtherHEALTHNET
P2551839OtherOXFORD
NJ8710201Medicaid
2079557000OtherAMERIHEALTH
H45874Medicare UPIN
2K2657OtherHEALTHNET