Healthcare Provider Details

I. General information

NPI: 1003084195
Provider Name (Legal Business Name): CHRISTOPHER MANETTA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 BLACK HORSE PIKE
HADDON HEIGHTS NJ
08035-1009
US

IV. Provider business mailing address

PO BOX 159
BARRINGTON NJ
08007-0159
US

V. Phone/Fax

Practice location:
  • Phone: 888-982-8594
  • Fax: 888-920-1525
Mailing address:
  • Phone: 888-982-8594
  • Fax: 888-982-8594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number304398-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS019785
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MB10752900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: