Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD00276100 | NJ |
Y | 222Z00000X | Podiatrist | 25MD00276100 | NJ |
N | 213E00000X | Podiatrist | 65005828 | NY |
N | 222Z00000X | Podiatrist | 65005828 | NY |
N | 213EP1101X | Primary Podiatric Medicine | 25MD00276100 | NJ |
N | 213EP1101X | Primary Podiatric Medicine | 65005828 | NY |
N | 213ES0131X | Foot Surgery | 25MD00276100 | NJ |
N | 213ES0131X | Foot Surgery | 65005828 | NY |
NPI | 1477552891 |
---|---|
Provider Name | Dr. Debra Beth Manheim |
First Address | West Orange, NJ 07052-3444 |
Second Address | Parsippany, NJ 07054-1278 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 07/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02264079 | (05) | NY |
P00650640 | RAILROAD (01) | NJ |
U92356 | (02) |