Provider Demographics
NPI:1598795411
Name:MANIYA, MARIAM Z (MD)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:Z
Last Name:MANIYA
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 1:941 WHITEHORSE AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610
Mailing Address - Country:US
Mailing Address - Phone:609-581-9100
Mailing Address - Fax:609-581-7588
Practice Address - Street 1:941 WHITEHORSE AVE
Practice Address - Street 2:STE 5
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08610
Practice Address - Country:US
Practice Address - Phone:609-581-9100
Practice Address - Fax:609-581-7588
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6824005Medicaid
NJ730701Medicare ID - Type Unspecified
NJ6824005Medicaid