Healthcare Provider Details

I. General information

NPI: 1083638464
Provider Name (Legal Business Name): VINCENT A MANJONEY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 MAIN ST 3RD FLOOR SOUTH
BRIDGEPORT CT
06606-5308
US

IV. Provider business mailing address

2720 MAIN ST 3RD FLOOR SOUTH
BRIDGEPORT CT
06606-5308
US

V. Phone/Fax

Practice location:
  • Phone: 203-579-7500
  • Fax: 203-576-0035
Mailing address:
  • Phone: 203-579-7500
  • Fax: 203-576-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number023089
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number023089
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number023089
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number023089
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number023089
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number023089
License Number StateCT
# 7
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number023089
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: