Basic Information
| Provider Information | |||||||||
| NPI: | 1932143112 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VARA | ||||||||
| FirstName: | MANJULA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 511 | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109240511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452944339 | ||||||||
| FaxNumber: | 8452944333 | ||||||||
| Practice Location | |||||||||
| Address1: | TRINITAS HOSPITAL | ||||||||
| Address2: | 225 WILLIAMSON ST | ||||||||
| City: | ELIZABETH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452944339 | ||||||||
| FaxNumber: | 8452944333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 10/22/2007 | ||||||||
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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 | 207ZP0101X | 144214 | NY | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
ID Information
| ID | Type | State | Issuer | Description | 0074187 | 05 | NJ | MEDICAID |