Provider Demographics
NPI:1679550297
Name:THAKKER, MANOJ M (MD)
Entity Type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:M
Last Name:THAKKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 TILTON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1827
Mailing Address - Country:US
Mailing Address - Phone:609-646-5200
Mailing Address - Fax:609-646-9868
Practice Address - Street 1:1500 TILTON RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1827
Practice Address - Country:US
Practice Address - Phone:609-646-5200
Practice Address - Fax:609-646-9868
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2016-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0011003207W00000X
WAMD00042397207W00000X
NJ25MA08673200207W00000X, 207WX0200X
MA237850207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0243833Medicaid
VT1011768Medicaid
H85758Medicare UPIN