Provider Demographics
NPI:1144656869
Name:MANISHA PANWALA LLC
Entity type:Organization
Organization Name:MANISHA PANWALA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:MANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANWALA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:917-415-0504
Mailing Address - Street 1:18 ENGLE ST APT 6U
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2826
Mailing Address - Country:US
Mailing Address - Phone:917-415-0504
Mailing Address - Fax:
Practice Address - Street 1:18 ENGLE ST APT 6U
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2826
Practice Address - Country:US
Practice Address - Phone:917-415-0504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ933723133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty