Healthcare Provider Details

I. General information

NPI: 1760404149
Provider Name (Legal Business Name): CARMEL-ANN MANIA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 SUMMIT AVENUE
HACKENSACK NJ
07601-1430
US

IV. Provider business mailing address

344 SUMMIT AVENUE
HACKENSACK NJ
07601-1430
US

V. Phone/Fax

Practice location:
  • Phone: 201-525-0707
  • Fax: 201-525-0785
Mailing address:
  • Phone: 201-525-0707
  • Fax: 201-525-0785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number38MC00178000
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1093908
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
Identifier222330671
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerBLUE CROSS/ BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: