Provider Demographics
NPI:1184967275
Name:MANTOS, THOMAS A (BS NUTRITION)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
Last Name:MANTOS
Suffix:
Gender:M
Credentials:BS NUTRITION
Other - Prefix:MR
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:MANTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS NUTRITION
Mailing Address - Street 1:1 GLOBE CT
Mailing Address - Street 2:SUITE 15
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1824
Mailing Address - Country:US
Mailing Address - Phone:732-219-9636
Mailing Address - Fax:732-224-1080
Practice Address - Street 1:1 GLOBE CT
Practice Address - Street 2:SUITE 15
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1824
Practice Address - Country:US
Practice Address - Phone:732-219-9636
Practice Address - Fax:732-224-1080
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist