1124017843 NPI number — DR. MANORAMA GUNTUNUR D.D.S

Table of content: DR. MANORAMA GUNTUNUR D.D.S (NPI 1124017843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124017843 NPI number — DR. MANORAMA GUNTUNUR D.D.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUNTUNUR
Provider First Name:
MANORAMA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S
Provider Gender Code:
F

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:
1124017843
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 CHAGALL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST WINDSOR
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08520-2989
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-371-5044
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7821 BERGENLINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BERGEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07047-4942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-869-0030
Provider Business Practice Location Address Fax Number:
201-869-0020
Provider Enumeration Date:
10/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DI20520 , 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: 1086983 . This is a "HORIZON HEALTH/MERCY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 20520 . This is a "DELTA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: AETNA . This is a "30536" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 985772 . This is a "UNITED CONCARDIA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 016386 . This is a "AMERIGROUP AND HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223354 . This is a "CIGNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7794509 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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