Provider Demographics
NPI:1316956972
Name:MANIPON, JENNIFER L (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MANIPON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 SANDRA DR
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-1131
Mailing Address - Country:US
Mailing Address - Phone:973-778-1134
Mailing Address - Fax:
Practice Address - Street 1:1011 CLIFTON AVE
Practice Address - Street 2:SUITE 5 2ND FLOOR
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3518
Practice Address - Country:US
Practice Address - Phone:973-778-1134
Practice Address - Fax:973-614-1530
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01160600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ126959OtherGHI
NJ126959OtherGHI