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General NPI Number Information
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NPI Number | 1053319962
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Entity Type | Individual
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Provider Name | MERVAT B MANSOUR M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 2 AUER CT STE D
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-5824
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Country | US
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Telephone | 732-257-5530
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Fax | 732-257-5531
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Provider Business Mailing Address
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Address Line | 26 GATES AVE
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816
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Country | US
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Telephone | 718-377-2834
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 220228
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 25MA08176800
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License Number State | NJ
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