Provider Demographics
NPI:1336177872
Name:MANCINI, DAVID ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANTHONY
Last Name:MANCINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:68 SOUTH SERVICE ROAD,
Mailing Address - Street 2:SUITE #350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:100 GRAND STREET
Practice Address - Street 2:
Practice Address - City:NEW BRITIAN
Practice Address - State:CT
Practice Address - Zip Code:06050-4411
Practice Address - Country:US
Practice Address - Phone:516-945-3000
Practice Address - Fax:516-945-3131
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029441207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1294412Medicaid
CT1294412Medicaid
CT050000733Medicare PIN