Healthcare Provider Details

I. General information

NPI: 1902735921
Provider Name (Legal Business Name): MANASA NIDAGALLE GOWDA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MEADOWLANDS PKWY
SECAUCUS NJ
07094-2977
US

IV. Provider business mailing address

2 CAITLIN CT
PRINCETON NJ
08540-9496
US

V. Phone/Fax

Practice location:
  • Phone: 201-392-3100
  • Fax:
Mailing address:
  • Phone: 732-379-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: