MEDICARE: MANESH MATHEW

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	2085R0202X	Diagnostic Radiology Physician	ME100435	FL
2	2085R0202X	Diagnostic Radiology Physician	25MA11453700	NJ
3	2085R0202X	Diagnostic Radiology Physician	MD423975	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841242112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANESH MATHEW

Provider Business Mailing Address
First Line	:	23625 COMMERCE PARK
Second Line	:	STE 204
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5845
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 OCEAN DR
Second Line	:	APT W8C
City	:	JUNO BEACH
State	:	FL
Zip	:	33408-1919
Country	:	US
Telephone Number	:	917-767-8584
Fax Number	:

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	06/11/2026

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Directions to “ MANESH MATHEW ” Practice Location

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