Healthcare Provider Details

I. General information

NPI: 1184665432
Provider Name (Legal Business Name): DOUGLAS M MANGANELLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 ROUTE 35 SUITE 2
OAKHURST NJ
07755-2765
US

IV. Provider business mailing address

1907 ROUTE 35 STE 2
OAKHURST NJ
07755-2760
US

V. Phone/Fax

Practice location:
  • Phone: 732-275-7779
  • Fax: 732-660-1998
Mailing address:
  • Phone: 732-275-7779
  • Fax: 732-660-1998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME52097
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MA53302
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: