Individual
MICHAEL JEROME MANGUAL-MARQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10 PARSONAGE RD STE 318, EDISON, NJ 08837-2429
(732) 204-1635
Mailing address
14 JANIE LN, CLARK, NJ 07066-1304
(732) 770-0734
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/13/2017
Last updated
10/13/2017
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