Individual
ILYA MANEVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1140 ROUTE 72 W, MANAHAWKIN, NJ 08050-2412
(609) 978-8900
Mailing address
125 PATERSON ST, SUITE 3100, NEW BRUNSWICK, NJ 08901-1962
(732) 235-7827
(732) 235-6131
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA08285400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0153362
—
NJ
01
—
P00644610
RR MCR PTAN
NJ
Enumeration date
12/03/2007
Last updated
01/12/2009
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