MEDICARE: MRS. IRINA MANKOVSKAYA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	21203	NJ
2	122300000X	Dentist	048876	NY

General Provider Information

NPI Number	:	1659389831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IRINA MANKOVSKAYA DDS

Provider Business Mailing Address
First Line	:	19 LONGFELLOW TER
Second Line	:
City	:	MORGANVILLE
State	:	NJ
Zip	:	07751
Country	:	US
Telephone Number	:	732-617-2688
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 HOOPER AVE
Second Line	:	UNITY DENTAL PC
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-8135
Country	:	US
Telephone Number	:	732-255-2900
Fax Number	:	732-255-4157

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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