Provider Demographics
NPI:1689629560
Name:MANOJ, SMITHA (MD)
Entity Type:Individual
Prefix:
First Name:SMITHA
Middle Name:
Last Name:MANOJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SMITHA
Other - Middle Name:
Other - Last Name:CHITRANGATHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:240 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2292
Mailing Address - Country:US
Mailing Address - Phone:732-549-3000
Mailing Address - Fax:732-549-3002
Practice Address - Street 1:240 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2292
Practice Address - Country:US
Practice Address - Phone:732-549-3000
Practice Address - Fax:732-549-3002
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07163700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH56608Medicare UPIN