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Contact Information

AUGUSTUS G MANTIA, MD
59 SOUTHERN BLVD
NESCONSET, NY11767-1090
 Phone: 631-659-1700
 Fax: 631-659-1750
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for AUGUSTUS G MANTIA · (Male)

NPI # 1588662829
Status Active
Credentials MD
Entity Individual
Enumeration date 07/11/2005
Last updated 04/22/2015 - About 11 years ago
Sole proprietor 1 No
Identifiers
  • NY License # 124142
  • NY Medicaid 002785973
Hospital affiliation(s)
  • ST CHARLES HOSPITAL - (Acute Care)
    200 BELLE TERRE ROAD
    PORT JEFFERSON, NY 11777
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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