Provider Demographics
NPI:1629459953
Name:MANASA HEALTH CENTER. LLC
Entity Type:Organization
Organization Name:MANASA HEALTH CENTER. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIDAGALLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOWDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-230-2529
Mailing Address - Street 1:3084 STATE ROUTE 27 STE 7
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1657
Mailing Address - Country:US
Mailing Address - Phone:732-230-2529
Mailing Address - Fax:732-274-2776
Practice Address - Street 1:2 CAITLIN CT
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-9496
Practice Address - Country:US
Practice Address - Phone:732-230-2529
Practice Address - Fax:732-274-2776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA078698002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0124729Medicaid