Individual
JOHN MANICONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
225 MILLBURN AVE, SUITE 104B, MILLBURN, NJ 07041-1737
(973) 379-5888
(973) 912-9757
Mailing address
225 MILLBURN AVE, SUITE 104B, MILLBURN, NJ 07041-1737
(973) 379-5888
(973) 912-9757
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
25MA05569400
NJ
208600000X
Surgery Physician
Primary
25MA05569400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0526328000
AMERIHEALTH #
NJ
01
—
0K3218
HEALTHNET #
NJ
01
—
1059497
HORIZON NJ HEALTH #
NJ
01
—
5093166
AETNA PPO #
NJ
01
—
5710066
GHI PPO #
NJ
01
—
575898
AETNA HMO #
NJ
05
—
6893201
—
NJ
01
—
770001140
RAILROAD MDCR #
NJ
01
—
84168
AMERIGROUP #
NJ
Enumeration date
07/22/2005
Last updated
12/12/2024
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