Provider Demographics
NPI:1952317570
Name:MANIAR, GINA SUZANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:SUZANNE
Last Name:MANIAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:9 SAM DR
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-4436
Mailing Address - Country:US
Mailing Address - Phone:732-389-5604
Mailing Address - Fax:732-389-5395
Practice Address - Street 1:425 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7732
Practice Address - Country:US
Practice Address - Phone:732-840-3380
Practice Address - Fax:732-389-5395
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB067232207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7585101Medicaid
NJG83808Medicare UPIN
NJ7585101Medicaid