Provider Demographics
NPI:1306130638
Name:MANUKYAN, KARINA (OPHTHALMIC DISPENSER)
Entity type:Individual
Prefix:MS
First Name:KARINA
Middle Name:
Last Name:MANUKYAN
Suffix:
Gender:F
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SPRING ST
Mailing Address - Street 2:UNIT 101
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2276
Mailing Address - Country:US
Mailing Address - Phone:732-246-6895
Mailing Address - Fax:
Practice Address - Street 1:1 SPRING ST
Practice Address - Street 2:UNIT 101
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2276
Practice Address - Country:US
Practice Address - Phone:732-246-6895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00373000156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0165441Medicaid