Provider Demographics
NPI:1215920012
Name:MANFREDI SURGICAL & ORTHOPEDIC CO., INC.
Entity type:Organization
Organization Name:MANFREDI SURGICAL & ORTHOPEDIC CO., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANFREDI
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:732-380-0366
Mailing Address - Street 1:749 HOPE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1432
Mailing Address - Country:US
Mailing Address - Phone:732-380-0366
Mailing Address - Fax:732-380-0245
Practice Address - Street 1:749 HOPE RD
Practice Address - Street 2:SUITE C
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1432
Practice Address - Country:US
Practice Address - Phone:732-380-0366
Practice Address - Fax:732-380-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00001100335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2641607Medicaid
NJ2641607Medicaid