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Individual

DR. CARMELITA MABANTA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
19 DAVIS AVE, NEPTUNE, NJ 07753-4488
(732) 776-4524
(732) 776-4639
Mailing address
19 DAVIS AVE, NEPTUNE, NJ 07753-4488
(732) 776-4524
(732) 776-4639

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
052399
GA
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
25MA08961100
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0304565
NJ
05
547197362B
GA
Enumeration date
11/28/2005
Last updated
11/11/2019
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