Healthcare Provider Details

I. General information

NPI: 1992615959
Provider Name (Legal Business Name): LAURA MANZANILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W CENTURY RD STE 150
PARAMUS NJ
07652-1436
US

IV. Provider business mailing address

175 BELGROVE DR
KEARNY NJ
07032-1507
US

V. Phone/Fax

Practice location:
  • Phone: 201-979-1336
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86481
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: