NPIMap

Organization Active NPI

Mantia Medical Associates

  • Family Medicine Physician
  • Smithtown, NY
National Provider Identifier
1477629400
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
182606 Issued in NY
Legal business name
MANTIA MEDICAL ASSOCIATES
Practice address
496 Nesconset Highway
Ste 200
Smithtown, NY 11787
Phone
(631) 265-9111
NPI assigned
Nov 28, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Augustus MantiaNPI 1588662829
Title
MD
Phone
(631) 265-9111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 182606 NY Primary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 094617 NY
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 124142 NY

Addresses

Primary practice location

496 Nesconset Highway
Ste 200
Smithtown, NY 11787

Mailing address

496 Nesconset Highway
Ste 200
Smithtown, NY 11787
Phone (631) 265-9111

Other identifiers 3

IdentifierTypeStateIssuer
155862MedicaidNY
2785973MedicaidNY
1577013MedicaidNY

Other names 1

  • 496 Nesconset Hwy Suite 200 Smithtown NY 11787 Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1477629400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "496 NESCONSET HIGHWAY",
            "address_2": "STE 200",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "11787",
            "telephone_number": "631-265-9111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "496 NESCONSET HIGHWAY",
            "address_2": "STE 200",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "11787",
            "telephone_number": "631-265-9111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANTIA MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "MANTIA",
        "authorized_official_first_name": "AUGUSTUS",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "631-265-9111"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "182606",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "094617",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "124142",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "155862",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2785973",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1577013",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "496 Nesconset Hwy Suite 200 Smithtown NY 11787",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Smithtown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.