Provider Demographics
NPI:1003340654
Name:MANI, SRINIWASAN
Entity Type:Individual
Prefix:
First Name:SRINIWASAN
Middle Name:
Last Name:MANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 ROBIN CT
Mailing Address - Street 2:
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-1736
Mailing Address - Country:US
Mailing Address - Phone:630-345-0559
Mailing Address - Fax:
Practice Address - Street 1:1028 ROBIN CT
Practice Address - Street 2:
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-1736
Practice Address - Country:US
Practice Address - Phone:630-345-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program