| Organization Name: | MANISHA PANWALA LLC |
| NPI Number: | 1144656869 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MANISHA PANWALA (REGISTERED DIETITIAN) |
| Mailing Address: | 18 Engle St Apt 6u Tenafly |
| State: | NJ US |
| Postal Code: | 076702826 |
| Phone Number: | 9174150504 |
| Fax Number: | |
| NPI Enumeration Date: | 09/26/2013 |
| NPI Last Update Date: | 09/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133VN1006X |
| License Number: | 933723 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | Nutrition, Metabolic |
| Taxonomy Definition: | |