Provider Demographics
NPI:1487636957
Name:MANZI, DANIEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:D
Last Name:MANZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 BLOOMFIELD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1301
Mailing Address - Country:US
Mailing Address - Phone:973-433-7600
Mailing Address - Fax:973-433-7462
Practice Address - Street 1:799 BLOOMFIELD AVE STE 102
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1301
Practice Address - Country:US
Practice Address - Phone:973-433-7600
Practice Address - Fax:973-433-7462
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03690300207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2095700Medicaid
NJD06602Medicare UPIN
NJ901490Medicare ID - Type Unspecified