Provider Demographics
NPI:1811982200
Name:MANGANARO, DAVID THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THOMAS
Last Name:MANGANARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 SHREWSBURY AVE STE 103B
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3006
Mailing Address - Country:US
Mailing Address - Phone:732-383-7310
Mailing Address - Fax:732-383-5924
Practice Address - Street 1:776 SHREWSBURY AVE STE 103B
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-3006
Practice Address - Country:US
Practice Address - Phone:732-383-7310
Practice Address - Fax:732-383-5924
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171066207R00000X
NJ25MA08934100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD92160Medicare UPIN
02F171Medicare PIN
NY02F171Medicare ID - Type Unspecified