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General NPI Number Information
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NPI Number | 1629459953
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Entity Type | Organization
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Legal Business Name | MANASA HEALTH CENTER. LLC
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 2 CAITLIN CT
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City | PRINCETON
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State | NJ
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Zip | 08540-9496
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Country | US
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Telephone | 732-230-2529
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Fax | 732-274-2776
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Provider Business Mailing Address
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Address Line | 3084 STATE ROUTE 27 STE 7
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City | KENDALL PARK
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State | NJ
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Zip | 08824-1657
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Country | US
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Telephone | 732-230-2529
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Fax | 732-274-2776
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. NIDAGALLE GOWDA
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Credential | M.D
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Telephone | 732-230-2529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA07869800
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License Number State | NJ
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