Provider Demographics
NPI:1386947794
Name:MANZELLA, KIMBERLY (LAC, MSTOM)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:MANZELLA
Suffix:
Gender:F
Credentials:LAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E. BAY AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08005
Mailing Address - Country:US
Mailing Address - Phone:609-978-1428
Mailing Address - Fax:
Practice Address - Street 1:102 E. BAY AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08005
Practice Address - Country:US
Practice Address - Phone:609-978-1428
Practice Address - Fax:609-978-1610
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00020700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist