Individual
AUGUSTUS G MANTIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
59 SOUTHERN BLVD, NESCONSET, NY 11767-1090
(631) 659-1700
(631) 659-1750
Mailing address
59 SOUTHERN BLVD, NESCONSET, NY 11767-1090
(631) 659-1700
(631) 659-1750
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
124142
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002785973
—
NY
Enumeration date
07/11/2005
Last updated
04/22/2015
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