| Gizelle Manoah, Pc, Inc | |
|
59 Main St Suite 204 West Orange NJ 07052-5341 | |
| (973) 243-0220 | |
| Not Available |
| Full Name | Gizelle Manoah, Pc, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 59 Main St, West Orange, New Jersey |
| Authorized Official Name and Position | Anne-marie Gizelle Gracia (PRESIDENT) |
| Authorized Official Contact | 9732430220 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gizelle Manoah, Pc, Inc Po Box 3122 Memorial Station Upper Montclair NJ 07043-3122 Ph: (973) 243-0220 | Gizelle Manoah, Pc, Inc 59 Main St Suite 204 West Orange NJ 07052-5341 Ph: (973) 243-0220 |
| NPI Number | 1225394075 |
|---|---|
| Provider Enumeration Date | 04/05/2012 |
| Last Update Date | 04/05/2012 |
| Medicare PECOS PAC ID | 4082866132 |
|---|---|
| Medicare Enrollment ID | O20121218000427 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225394075 | NPI | - | NPPES |
| 6560610 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | MA58440 (New Jersey) | Primary |
| Provider Name | Anne-marie G Gracia |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1447328018 PECOS PAC ID: 7113973645 Enrollment ID: I20050328000521 |
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