Healthcare Provider Details

I. General information

NPI: 1780147835
Provider Name (Legal Business Name): LAKSHMI MANISHA MUMMADISINGU D.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2019
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MAPLE AVE STE 3B
RED BANK NJ
07701-1729
US

IV. Provider business mailing address

7600 RIVER RD
NORTH BERGEN NJ
07047-6217
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00370200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00370200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: