Provider Demographics
NPI:1821225137
Name:MANALAPAN MEDICAL CENTER PA PC
Entity Type:Organization
Organization Name:MANALAPAN MEDICAL CENTER PA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-845-2200
Mailing Address - Street 1:345 ROUTE 9 SOUTH
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726
Mailing Address - Country:US
Mailing Address - Phone:732-845-2200
Mailing Address - Fax:732-845-0501
Practice Address - Street 1:345 ROUTE 9 SOUTH
Practice Address - Street 2:SUITE 9
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726
Practice Address - Country:US
Practice Address - Phone:732-845-2200
Practice Address - Fax:732-845-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25 MA07690600207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty