Provider Demographics
NPI:1881630853
Name:MANZO, RENE (MD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:
Last Name:MANZO
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 1:26 MARLBORO RD
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:NJ
Mailing Address - Zip Code:07421-2412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 POCONO RD
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2954
Practice Address - Country:US
Practice Address - Phone:973-625-6662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA067382002085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
011383Medicare ID - Type Unspecified
G49413Medicare UPIN