Provider Demographics
NPI:1952138737
Name:MANON-OG, JOHANNAH P
Entity type:Individual
Prefix:
First Name:JOHANNAH
Middle Name:P
Last Name:MANON-OG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6727
Mailing Address - Country:US
Mailing Address - Phone:908-380-6097
Mailing Address - Fax:
Practice Address - Street 1:810 MADISON AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6727
Practice Address - Country:US
Practice Address - Phone:908-380-6097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist