Provider Demographics
NPI:1497892319
Name:MANIAR, MADHAVI NITIN (MD)
Entity Type:Individual
Prefix:
First Name:MADHAVI
Middle Name:NITIN
Last Name:MANIAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 WASHINGTON ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017
Mailing Address - Country:US
Mailing Address - Phone:973-676-2492
Mailing Address - Fax:973-676-5901
Practice Address - Street 1:90 WASHINGTON ST
Practice Address - Street 2:SUITE 305
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017
Practice Address - Country:US
Practice Address - Phone:973-676-2492
Practice Address - Fax:973-676-5901
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA034395208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0780405Medicaid
C54815Medicare UPIN