1093706814 NPI number — KARL MANSER, P.T., P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093706814 NPI number — KARL MANSER, P.T., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KARL MANSER, P.T., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093706814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 ENGLE ST
Provider Second Line Business Mailing Address:
SUITE 17
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07631-2440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-569-2320
Provider Business Mailing Address Fax Number:
201-569-2321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 ENGLE ST
Provider Second Line Business Practice Location Address:
SUITE 17
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07631-2440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-569-2320
Provider Business Practice Location Address Fax Number:
201-569-2321
Provider Enumeration Date:
11/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MANSER
Authorized Official First Name:
KARL
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
201-569-2320

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  40QA00251000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2094975 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: NJ4514 . This is a "HEALTHNET PROVIDER ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: Q82921 . This is a "EMPIRE BC PROVIDER ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P1673774 . This is a "OXFORD PROVIDER ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 647147 . This is a "UNITED HEALTHCARE ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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