Provider Demographics
NPI:1881141117
Name:GEORGE MANJA LLC
Entity type:Organization
Organization Name:GEORGE MANJA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-892-0999
Mailing Address - Street 1:430 NAZARETH PIKE
Mailing Address - Street 2:LOWER LEVER
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-9615
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:430 NAZARETH PIKE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-9615
Practice Address - Country:US
Practice Address - Phone:484-892-0999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy