Provider Demographics
NPI:1629089719
Name:RENTALA, MANJUSHA (MD)
Entity Type:Individual
Prefix:
First Name:MANJUSHA
Middle Name:
Last Name:RENTALA
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 1:229 W 60TH ST APT 230
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7497
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:651 WEST MT. PLEASANT AVE
Practice Address - Street 2:KINGSTON EMERGENCY MEDICINE MEDICAL ASSOCIATES
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-740-0607
Practice Address - Fax:973-251-1109
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85168207P00000X
NY202739207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G851680Medicaid
CA00G851680Medicaid
G88185Medicare UPIN