Provider Demographics
NPI:1477552891
Name:MANHEIM, DEBRA BETH (DPM)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:BETH
Last Name:MANHEIM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 CLARKEN DR
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3444
Mailing Address - Country:US
Mailing Address - Phone:973-917-3785
Mailing Address - Fax:973-917-3786
Practice Address - Street 1:3219 ROUTE 46
Practice Address - Street 2:SUITE 210
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1278
Practice Address - Country:US
Practice Address - Phone:973-917-3785
Practice Address - Fax:973-917-3786
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00276100213E00000X, 213EP1101X, 213ES0131X
NY65005828213E00000X, 213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02264079Medicaid
NJP00650640OtherRAILROAD
NJ080463Medicare PIN
NJ080463ZFXJMedicare PIN
NJP00650640OtherRAILROAD
NY02264079Medicaid
NY30891MMedicare PIN