Provider Demographics
NPI:1710255005
Name:MANEK, JAYDEEP C (MS, RPH)
Entity Type:Individual
Prefix:MR
First Name:JAYDEEP
Middle Name:C
Last Name:MANEK
Suffix:
Gender:M
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07108-2809
Mailing Address - Country:US
Mailing Address - Phone:973-273-1100
Mailing Address - Fax:973-273-1288
Practice Address - Street 1:194 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-2809
Practice Address - Country:US
Practice Address - Phone:973-273-1100
Practice Address - Fax:973-273-1288
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02915000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist