Basic Information
| Provider Information | |||||||||
| NPI: | 1548216393 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANSURI | ||||||||
| FirstName: | HANIF | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 119 | ||||||||
| Address2: | |||||||||
| City: | CLIFFSIDE PK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070100119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006240792 | ||||||||
| FaxNumber: | 2019438105 | ||||||||
| Practice Location | |||||||||
| Address1: | 727 N BEERS ST | ||||||||
| Address2: | |||||||||
| City: | HOLMDEL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077331514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006240792 | ||||||||
| FaxNumber: | 2019438105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25MA03595200 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.