Provider Demographics
NPI:1902037203
Name:MANZELLA, ANTHONY J (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:MANZELLA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MADISON AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2734
Mailing Address - Country:US
Mailing Address - Phone:201-342-4100
Mailing Address - Fax:
Practice Address - Street 1:22 MADISON AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2734
Practice Address - Country:US
Practice Address - Phone:201-342-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01319200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist