Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DI02195300 | NJ |
NPI | 1487681037 |
---|---|
Provider Name | Manolis G Manolakakis |
First Address | Shrewsbury, NJ 07702-4329 |
Second Address | Shrewsbury, NJ 07702-4329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 01/08/2012 |