1245244656 NPI number — DR. MANOJ KHANNA OD

Table of content: DR. MANOJ KHANNA OD (NPI 1245244656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245244656 NPI number — DR. MANOJ KHANNA OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHANNA
Provider First Name:
MANOJ
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1245244656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 CHESTNUT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR KNOLLS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07927-1400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-450-4239
Provider Business Mailing Address Fax Number:
973-588-3941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 WOODBRIDGE CENTER DRIVE
Provider Second Line Business Practice Location Address:
CLVC
Provider Business Practice Location Address City Name:
WOODBRIDE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07095-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-450-4239
Provider Business Practice Location Address Fax Number:
973-588-3941
Provider Enumeration Date:
07/28/2006

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: 152W00000X , with the licence number:  0EG001493 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 27OA00611000 , 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: PA00519 . This is a "VBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1245244656 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: KH1642005 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA1493 . This is a "EYEMED" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60588 . This is a "SPECTERA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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