Provider Demographics
NPI:1932143112
Name:VARA, MANJULA (MD)
Entity type:Individual
Prefix:
First Name:MANJULA
Middle Name:
Last Name:VARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 RAMONA AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2611
Mailing Address - Country:US
Mailing Address - Phone:917-670-4695
Mailing Address - Fax:
Practice Address - Street 1:1818 E ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-1410
Practice Address - Country:US
Practice Address - Phone:908-583-5421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144214207ZP0101X
NJ25MA0387750207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0074187Medicaid
NJ0074187Medicaid
NYE62512Medicare UPIN
NY66F951Medicare UPIN