Provider Demographics
NPI:1811009558
Name:MANZULLO, GREGORY P (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
Last Name:MANZULLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 COMMONS WAY
Mailing Address - Street 2:BLD. A100
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6426
Mailing Address - Country:US
Mailing Address - Phone:732-818-7561
Mailing Address - Fax:732-818-7510
Practice Address - Street 1:100 COMMONS WAY
Practice Address - Street 2:BLD. A100
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6426
Practice Address - Country:US
Practice Address - Phone:732-818-7561
Practice Address - Fax:732-818-7510
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05812800207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG20975Medicare UPIN
NJ829457Medicare ID - Type Unspecified