MEDICARE: BRICKNER MANTELL CENTER FOR WOMEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	25MB05622800	NJ

General Provider Information

NPI Number	:	1700900651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRICKNER MANTELL CENTER FOR WOMEN

Provider Business Mailing Address
First Line	:	1A QUAKERBRIDGE PLZ
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08619-1241
Country	:	US
Telephone Number	:	609-689-9991
Fax Number	:	609-689-9992

Provider Business Practice Location Address
First Line	:	1A QUAKERBRIDGE PLZ
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08619-1241
Country	:	US
Telephone Number	:	609-689-9991
Fax Number	:	609-689-9992

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CARY H MANTELL
Credential	:	DO
Telephone Number	:	609-689-9994

Provider Enumeration Date	:	03/18/2007
Last Update Date	:	08/22/2020

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