Provider Demographics
NPI:1467520882
Name:MANUEL R. MORMAN, PH.D., M.D., P.A.
Entity Type:Organization
Organization Name:MANUEL R. MORMAN, PH.D., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD
Authorized Official - Phone:201-460-0283
Mailing Address - Street 1:47 ORIENT WAY
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2082
Mailing Address - Country:US
Mailing Address - Phone:201-460-0283
Mailing Address - Fax:201-460-8084
Practice Address - Street 1:47 ORIENT WAY
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2082
Practice Address - Country:US
Practice Address - Phone:201-460-0283
Practice Address - Fax:201-460-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37695207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3175804Medicaid
NJMA597353Medicare PIN
NJC53771Medicare UPIN