Healthcare Provider Details

I. General information

NPI: 1659387264
Provider Name (Legal Business Name): MIHIR KISHOR MANIAR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 NJ-35
EATONTOWN NJ
07724
US

IV. Provider business mailing address

135 NJ-35
EATONTOWN NJ
07724-4436
US

V. Phone/Fax

Practice location:
  • Phone: 848-300-2210
  • Fax: 848-300-2207
Mailing address:
  • Phone: 848-300-2210
  • Fax: 848-300-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMB67501
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: