Provider Demographics
NPI:1295167807
Name:MANN, MAYA (PA-C)
Entity type:Individual
Prefix:MS
First Name:MAYA
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 PENNINGTON RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-1301
Mailing Address - Country:US
Mailing Address - Phone:609-883-4124
Mailing Address - Fax:609-883-0031
Practice Address - Street 1:1539 PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-1301
Practice Address - Country:US
Practice Address - Phone:609-883-4124
Practice Address - Fax:609-883-0031
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00314700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine