Provider Demographics
NPI:1568674786
Name:DANIEL MANSKE MD
Entity Type:Organization
Organization Name:DANIEL MANSKE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MANSKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-459-3500
Mailing Address - Street 1:154 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-1806
Mailing Address - Country:US
Mailing Address - Phone:856-459-3500
Mailing Address - Fax:856-459-3600
Practice Address - Street 1:154 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1806
Practice Address - Country:US
Practice Address - Phone:856-459-3500
Practice Address - Fax:856-459-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO62223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
556198OtherAETNA PRACTICE ID
NJ01000245802OtherAMERICHOICE OF NJ NUMBER
NJ1166159OtherHNJH PROVIDER NUMBER
0543609000OtherAMERIHEALTH PRACTICE ID
NJ6587208Medicaid
NJ6587208Medicaid
NJ1166159OtherHNJH PROVIDER NUMBER