MEDICARE: DR. DAVID THOMAS MANGANARO MD

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	207R00000X	Internal Medicine Physician	171066	NY
2	207R00000X	Internal Medicine Physician	25MA08934100	NJ

General Provider Information

NPI Number	:	1811982200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID THOMAS MANGANARO MD

Provider Business Mailing Address
First Line	:	776 SHREWSBURY AVE STE 103B
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-3006
Country	:	US
Telephone Number	:	732-383-7310
Fax Number	:	732-383-5924

Provider Business Practice Location Address
First Line	:	776 SHREWSBURY AVE STE 103B
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-3006
Country	:	US
Telephone Number	:	732-383-7310
Fax Number	:	732-383-5924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	12/05/2018

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