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General NPI Number Information
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NPI Number | 1093957813
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Entity Type | Individual
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Provider Name | MISS JANINE MARY MANSUKHANI
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Gender | Female
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 350 ENGLE ST FL 5
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-1808
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Country | US
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Telephone | 201-894-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 40 CONCORD LN
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City | STATEN ISLAND
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State | NY
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Zip | 10304-1343
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Country | US
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Telephone | 646-823-4212
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 013151
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00653600
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License Number State | NJ
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