Manolis G Manolakakis, DMD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

DI02195300 Issued in NJ

Practice address

1131 Broad St
Suite 109
Shrewsbury, NJ 07702-4329

Phone

(732) 542-0755

Fax

(732) 542-7272

NPI assigned

Jun 27, 2006

Last updated

Aug 1, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2016 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cooper Surgical Associates

  • Urology Physician
  • Cherry Hill, NJ
  • NPI 1083732143
  NPD (past)

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343779200000",
    "number": "1487681037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1131 BROAD ST",
            "address_2": "SUITE 109",
            "city": "SHREWSBURY",
            "state": "NJ",
            "postal_code": "077024329",
            "telephone_number": "732-542-0755",
            "fax_number": "732-542-7272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1131 BROAD ST",
            "address_2": "SUITE 109",
            "city": "SHREWSBURY",
            "state": "NJ",
            "postal_code": "077024329",
            "telephone_number": "732-542-0755",
            "fax_number": "732-542-7272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANOLAKAKIS",
        "first_name": "MANOLIS",
        "middle_name": "G",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2012-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NJ",
            "license": "DI02195300",
            "primary": true
        },
        {
            "code": "2082S0099X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": "NJ",
            "license": "22DIO2195300",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lori A. Magoulas, PH.D., R.D.
• Peter J. Magoulas, D.D.S.
• Beth E Maguire, LCSW
• Robert Mako, DO
• Manalapan Anesthesia Associates, LLC
• Gabriella Maoli, OTR/L
• Phyllis Marberry, CRNA
• Marc S Menkowitz MD LLC
• Catherine Margel
• Diana Marinaro, LCSW

• Oral & Maxillofacial Surgery (D.M.D.) in Shrewsbury, NJ
• Providers in Shrewsbury, NJ by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.