Provider Demographics
NPI:1245244656
Name:KHANNA, MANOJ (OD)
Entity Type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:
Last Name:KHANNA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1400
Mailing Address - Country:US
Mailing Address - Phone:215-450-4239
Mailing Address - Fax:973-588-3941
Practice Address - Street 1:161 WOODBRIDGE CENTER DRIVE
Practice Address - Street 2:CLVC
Practice Address - City:WOODBRIDE
Practice Address - State:NJ
Practice Address - Zip Code:07095-9998
Practice Address - Country:US
Practice Address - Phone:215-450-4239
Practice Address - Fax:973-588-3941
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG001493152W00000X
NJ27OA00611000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA00519OtherVBA
NJ1245244656OtherAETNA
PAKH1642005OtherHIGHMARK BLUE SHIELD
NJPA1493OtherEYEMED
NJ60588OtherSPECTERA