Individual
JOHN OLIVER MANANSALA HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
54 FREDERICK ST, HACKENSACK, NJ 07601-5235
(201) 249-1395
Mailing address
54 FREDERICK ST, HACKENSACK, NJ 07601-5235
(201) 249-1395
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
40QA01620600
NJ
Other
Enumeration date
09/09/2015
Last updated
09/09/2015
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