Organization
SHORE SURGICAL PAVILION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS MANGANELLI M.D. (MEDICAL DIRECTOR)
(732) 730-3939
Entity
Organization
Contact information
Practice address
475 ROUTE 70, SUITE 202, LAKEWOOD, NJ 08701-5897
(732) 730-3939
(732) 730-9119
Mailing address
475 ROUTE 70, SUITE 202, LAKEWOOD, NJ 08701-5897
(732) 730-3939
(732) 730-9119
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
11/17/2010
Last updated
11/19/2019
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