Provider Demographics
NPI:1427375815
Name:MANZAR, MAIMOONA
Entity Type:Individual
Prefix:
First Name:MAIMOONA
Middle Name:
Last Name:MANZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3007
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-0007
Mailing Address - Country:US
Mailing Address - Phone:609-587-2300
Mailing Address - Fax:
Practice Address - Street 1:2087 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3416
Practice Address - Country:US
Practice Address - Phone:609-587-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered