Healthcare Provider Details

I. General information

NPI: 1164990933
Provider Name (Legal Business Name): JARED C MANNELLO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BAY AVE STE 3
SOMERS POINT NJ
08244-2656
US

IV. Provider business mailing address

23 N DELSEA DR UNIT B
CLAYTON NJ
08312-1637
US

V. Phone/Fax

Practice location:
  • Phone: 609-350-6680
  • Fax:
Mailing address:
  • Phone: 856-423-7000
  • Fax: 856-423-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JARED C MANNELLO
Title or Position: SOLE MEMBER
Credential: PT DPT OCS
Phone: 856-423-7700