Provider Demographics
NPI:1548216393
Name:MANSURI, HANIF M (MD)
Entity type:Individual
Prefix:
First Name:HANIF
Middle Name:M
Last Name:MANSURI
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:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-0119
Mailing Address - Country:US
Mailing Address - Phone:800-624-0792
Mailing Address - Fax:201-943-8105
Practice Address - Street 1:727 N BEERS ST
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1514
Practice Address - Country:US
Practice Address - Phone:800-624-0792
Practice Address - Fax:201-943-8105
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03595200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54705Medicare UPIN
NJ444706Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER