Healthcare Provider Details

I. General information

NPI: 1194629600
Provider Name (Legal Business Name): KUMBA MANSARAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 CHEWS LANDING RD
CLEMENTON NJ
08021-2702
US

IV. Provider business mailing address

63 CLEMENS LN
BLACKWOOD NJ
08012-5824
US

V. Phone/Fax

Practice location:
  • Phone: 267-815-3623
  • Fax: 856-666-0156
Mailing address:
  • Phone: 267-815-3623
  • Fax: 856-666-0156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHP0446900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: