Basic Information
| Provider Information | |||||||||
| NPI: | 1316956972 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANIPON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 65 SANDRA DR | ||||||||
| Address2: | |||||||||
| City: | TOTOWA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 075121131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737781134 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1011 CLIFTON AVE | ||||||||
| Address2: | SUITE 5 2ND FLOOR | ||||||||
| City: | CLIFTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070133518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737781134 | ||||||||
| FaxNumber: | 9736141530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 03/20/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01160600 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 126959 | 01 | NJ | GHI | OTHER |