Organization
GIZELLE MANOAH, PC, INC
Active
Parent organization
GIZELLEMANOAH, PC, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GIZELLEMANOAH, PC, INC
Authorized official
ANNE-MARIE GIZELLE GRACIA MD (PRESIDENT)
(973) 243-0220
Entity
Organization
Contact information
Practice address
59 MAIN ST, SUITE 204, WEST ORANGE, NJ 07052-5341
(973) 243-0220
Mailing address
PO BOX 3122, MEMORIAL STATION, UPPER MONTCLAIR, NJ 07043-3122
(973) 243-0220
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
MA58440
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6560610
—
NJ
Enumeration date
04/05/2012
Last updated
04/05/2012
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