Provider Demographics
NPI:1356389860
Name:MANSKE, DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:MANSKE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-1806
Mailing Address - Country:US
Mailing Address - Phone:856-459-3500
Mailing Address - Fax:856-459-3600
Practice Address - Street 1:154 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1806
Practice Address - Country:US
Practice Address - Phone:856-459-3500
Practice Address - Fax:856-459-3600
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA062223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6587208Medicaid
NJ707710Medicare PIN
NJ6587208Medicaid