Individual
MR. JOHN R MANZELLA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1353 STATE ROUTE 903, JIM THORPE, PA 18229-2734
(570) 325-8393
(570) 325-8029
Mailing address
1353 STATE ROUTE 903, JIM THORPE, PA 18229-2734
(570) 325-8393
(570) 325-8029
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
OS010263L
PA
208000000X
Pediatrics Physician
OS010263L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001780247
—
PA
01
—
010054200
BLACK LUNG
—
01
—
0314295000
PERSONAL BLUE SHIELD
—
01
—
03197301
CAPITAL BLUE CROSS
—
01
—
1753980
FEDERAL BLUE SHIELD
—
01
—
176513
BLUE SHIELD
PA
01
—
176513
AMERIHEALTH ADMIN
—
01
—
20031252
AMERIHEALTH MERCY
—
01
—
2968846
GHI
—
01
—
5389099
AETNA
—
01
—
P00600418
PALMETTO
PA
Enumeration date
12/06/2005
Last updated
07/08/2008
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