Provider Demographics
NPI:1114290319
Name:MANZO, MELISSA (OD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:MANZO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 WALLIS AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-6416
Mailing Address - Country:US
Mailing Address - Phone:201-618-9722
Mailing Address - Fax:
Practice Address - Street 1:3196 KENNEDY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2468
Practice Address - Country:US
Practice Address - Phone:201-863-9013
Practice Address - Fax:201-863-8431
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00637100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist