Provider Demographics
NPI:1366438210
Name:MANASSE, JOSIANNE (OD)
Entity type:Individual
Prefix:DR
First Name:JOSIANNE
Middle Name:
Last Name:MANASSE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 ROUTE 10 EAST
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936
Mailing Address - Country:US
Mailing Address - Phone:973-781-0800
Mailing Address - Fax:973-781-0045
Practice Address - Street 1:389 ROUTE 10 EAST
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936
Practice Address - Country:US
Practice Address - Phone:973-781-0800
Practice Address - Fax:973-781-0045
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJDA5745152W00000X
NJDA1143152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8624208Medicaid
3685183OtherAETNA
U89259Medicare UPIN
3685183OtherAETNA