Provider Demographics
NPI:1992700207
Name:MANFORTI, ALFONSO J JR (DC)
Entity type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:J
Last Name:MANFORTI
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 LAKEHURST RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8043
Mailing Address - Country:US
Mailing Address - Phone:732-505-6064
Mailing Address - Fax:
Practice Address - Street 1:541 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8043
Practice Address - Country:US
Practice Address - Phone:732-244-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC01976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ427264Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NJT44925Medicare UPIN