Provider Demographics
NPI:1316178932
Name:MANU, JACOB (LPN)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:MANU
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-3281
Mailing Address - Country:US
Mailing Address - Phone:862-576-8553
Mailing Address - Fax:
Practice Address - Street 1:85 MANOR DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-3281
Practice Address - Country:US
Practice Address - Phone:862-576-8553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296356164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse