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General NPI Number Information
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NPI Number | 1245244656
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Entity Type | Individual
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Provider Name | MANOJ KHANNA OD
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 11/19/2011
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Provider Practice Location Address
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Address Line | 161 WOODBRIDGE CENTER DRIVE CLVC
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City | WOODBRIDE
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State | NJ
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Zip | 07095-9998
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Country | US
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Telephone | 215-450-4239
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Fax | 973-588-3941
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Provider Business Mailing Address
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Address Line | 5 CHESTNUT RD
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City | CEDAR KNOLLS
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State | NJ
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Zip | 07927-1400
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Country | US
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Telephone | 215-450-4239
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Fax | 973-588-3941
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0EG001493
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00611000
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License Number State | NJ
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