Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 26NJ00677800 | NJ |
NPI | 1003367509 |
---|---|
Provider Name | Jennifer Manzo |
First Address | Toms River, NJ 08755-1490 |
Second Address | Toms River, NJ 08755-1490 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2016 |
Last Update Date | 19/10/2016 |