Provider Demographics
NPI:1912054446
Name:GEORGE, MANJU ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MANJU
Middle Name:ELIZABETH
Last Name:GEORGE
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 1:3355 BURNS RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4353
Mailing Address - Country:US
Mailing Address - Phone:561-804-7546
Mailing Address - Fax:561-804-7543
Practice Address - Street 1:3355 BURNS RD
Practice Address - Street 2:SUITE 204
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4353
Practice Address - Country:US
Practice Address - Phone:561-804-7546
Practice Address - Fax:561-804-7543
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95018174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME95018OtherLICENSE #
FLME95018OtherLICENSE #