Healthcare Provider Details

I. General information

NPI: 1700813748
Provider Name (Legal Business Name): KAREN ELIZABETH MANISTA ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 KENT PLACE BLVD
SUMMIT NJ
07901-4704
US

IV. Provider business mailing address

100 SEAVIEW AVE 5-9
MONMOUTH BEACH NJ
07750-1256
US

V. Phone/Fax

Practice location:
  • Phone: 908-273-1494
  • Fax:
Mailing address:
  • Phone: 732-571-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number25MT00002800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: