Healthcare Provider Details

I. General information

NPI: 1770433997
Provider Name (Legal Business Name): MARIA J MANZANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 CENTRAL AVE FL 3
EAST ORANGE NJ
07018-1951
US

IV. Provider business mailing address

576 CENTRAL AVE STE 300
EAST ORANGE NJ
07018-1943
US

V. Phone/Fax

Practice location:
  • Phone: 973-259-8777
  • Fax:
Mailing address:
  • Phone: 973-259-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15515400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: