Individual
MANASI REVANKAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
185 ROSEBERRY ST, PHILLIPSBURG, NJ 08865-1690
(484) 526-6643
(484) 526-4658
Mailing address
801 OSTRUM ST, ST. LUKE'S ENROLLMENT CENTER, BETHLEHEM, PA 18015
(484) 526-8046
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MB09074300
NJ
207Q00000X
Family Medicine Physician
262304
NY
Other
Enumeration date
09/22/2008
Last updated
09/02/2016
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