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General NPI Number Information
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NPI Number | 1467520882
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Entity Type | Organization
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Legal Business Name | MANUEL R. MORMAN, PH.D., M.D., P.A.
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 47 ORIENT WAY
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City | RUTHERFORD
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State | NJ
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Zip | 07070-2082
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Country | US
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Telephone | 201-460-0283
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Fax | 201-460-8084
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Provider Business Mailing Address
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Address Line | 47 ORIENT WAY
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City | RUTHERFORD
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State | NJ
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Zip | 07070-2082
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Country | US
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Telephone | 201-460-0283
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Fax | 201-460-8084
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANUEL RICHARD MORMAN
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Credential | PH.D., M.D.
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Telephone | 201-460-0283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MA37695
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License Number State | NJ
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