Provider Demographics
NPI:1457480543
Name:MANALANG, ANDREI M (PT)
Entity Type:Individual
Prefix:MR
First Name:ANDREI
Middle Name:M
Last Name:MANALANG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 FLORAL TER
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2449
Mailing Address - Country:US
Mailing Address - Phone:201-266-4695
Mailing Address - Fax:
Practice Address - Street 1:1777 HAMBURG TPKE
Practice Address - Street 2:SUITE 105
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5211
Practice Address - Country:US
Practice Address - Phone:862-248-0840
Practice Address - Fax:862-248-0841
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00694800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist