Healthcare Provider Details

I. General information

NPI: 1154285328
Provider Name (Legal Business Name): MANSOUR MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 LONGVIEW DR
COLTS NECK NJ
07722-1189
US

IV. Provider business mailing address

32 LONGVIEW DR
COLTS NECK NJ
07722-1189
US

V. Phone/Fax

Practice location:
  • Phone: 732-241-4074
  • Fax:
Mailing address:
  • Phone: 732-241-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LORI SKALITZA
Title or Position: MANAGER
Credential:
Phone: 908-675-1590