=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326857046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANA HEALTH PARTNERS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2025
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 E CATHEDRAL RD STE 45
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19128-2128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-552-8922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 338 WHITESVILLE RD STE 103
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08527-5097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-552-8922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR ANCILLARY SERVICES
-----------------------------------------------------
Name | MITCH SCHWARZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-552-8922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------