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General NPI Number Information
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NPI Number | 1689250078
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Entity Type | Individual
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Provider Name | JAMES MANTAS
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Gender | Male
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 43 NEW SCOTLAND AVE
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City | ALBANY
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State | NY
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Zip | 12208-3478
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Country | US
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Telephone | 518-262-3125
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BROADWAY APT 207
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City | MENANDS
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State | NY
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Zip | 12204-2858
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Country | US
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Telephone | 518-376-0668
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 331596
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License Number State | NY
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