Provider Demographics
NPI:1932276631
Name:MANTOVANI, RAYMOND P (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:P
Last Name:MANTOVANI
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 1:1301 ROUTE 72 W
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2417
Mailing Address - Country:US
Mailing Address - Phone:609-597-6513
Mailing Address - Fax:609-597-4593
Practice Address - Street 1:1301 ROUTE 72 W
Practice Address - Street 2:SUITE 300
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2417
Practice Address - Country:US
Practice Address - Phone:609-597-6513
Practice Address - Fax:609-597-4593
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA47287207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223012814OtherQUALCARE
NJ0083782000OtherAMERIHEALTH
NJ223012814OtherHORIZON
NJ223012814OtherATLANTICARE
NJ223012814OtherDEVON
NJ0301608Medicaid
NJF01491OtherHEALTH NET
NJ0000145140Medicare NSC
NJ223012814OtherHORIZON