1457480543 NPI number — MR. ANDREI M MANALANG PT

Table of content: MR. ANDREI M MANALANG PT (NPI 1457480543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457480543 NPI number — MR. ANDREI M MANALANG PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANALANG
Provider First Name:
ANDREI
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1457480543
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
57 FLORAL TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TENAFLY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07670-2449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-266-4695
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1777 HAMBURG TPKE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07470-5211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
862-248-0840
Provider Business Practice Location Address Fax Number:
862-248-0841
Provider Enumeration Date:
03/05/2007

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: 225100000X , with the licence number:  40QA00694800 , 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)





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