Basic Information
| Provider Information | |||||||||
| NPI: | 1659568509 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANE | ||||||||
| FirstName: | SUPRIYA | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 CRESTWOOD DR | ||||||||
| Address2: | |||||||||
| City: | PISCATAWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088547502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327547166 | ||||||||
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| Practice Location | |||||||||
| Address1: | 380 DEMOTT LN | ||||||||
| Address2: | REGENCY HERITAGE NURSING CENTER | ||||||||
| City: | SOMERSET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088732762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328732000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2007 | ||||||||
| LastUpdateDate: | 09/25/2007 | ||||||||
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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 | 225X00000X | 46TR00208600 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.