Provider Demographics
NPI:1811930639
Name:MANSTEIN SURGICAL ASSOC
Entity type:Organization
Organization Name:MANSTEIN SURGICAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:MANSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-379-5700
Mailing Address - Street 1:821 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-8365
Mailing Address - Country:US
Mailing Address - Phone:215-379-5700
Mailing Address - Fax:215-379-2520
Practice Address - Street 1:821 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 120
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-8365
Practice Address - Country:US
Practice Address - Phone:215-379-5700
Practice Address - Fax:215-379-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0052464000OtherKEYSTONE
PA111102201Medicaid