Provider Demographics
NPI:1639234503
Name:MANALAPAN HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:MANALAPAN HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:HO
Authorized Official - Phone:732-446-8345
Mailing Address - Street 1:120 ROUTE 522 AND TAYLORS MILLS ROAD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726
Mailing Address - Country:US
Mailing Address - Phone:732-446-8345
Mailing Address - Fax:732-446-1576
Practice Address - Street 1:120 ROUTE 522 AND TAYLORS MILLS ROAD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726
Practice Address - Country:US
Practice Address - Phone:732-446-8345
Practice Address - Fax:732-446-1576
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWNSHIP OF MANALAPAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-22
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJA476251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ181528Medicare PIN