1568674786 NPI number — DANIEL MANSKE MD

Table of content: (NPI 1568674786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568674786 NPI number — DANIEL MANSKE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL MANSKE MD
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:
1568674786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
154 W COMMERCE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGETON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08302-1806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-459-3500
Provider Business Mailing Address Fax Number:
856-459-3600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
154 W COMMERCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08302-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-459-3500
Provider Business Practice Location Address Fax Number:
856-459-3600
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MANSKE
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PROPRIETOR
Authorized Official Telephone Number:
856-459-3500

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MAO62223 , 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: 556198 . This is a "AETNA PRACTICE ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01000245802 . This is a "AMERICHOICE OF NJ NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1166159 . This is a "HNJH PROVIDER NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0543609000 . This is a "AMERIHEALTH PRACTICE ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6587208 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com