Niveditha Jagalur Manjunatha

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

042057 Issued in NY

Practice address

9470 Annapolis Rd Ste 416
Lanham, MD 20706-3000

Phone

(240) 770-3505

Fax

(240) 770-4303

NPI assigned

Apr 1, 2018

Last updated

Oct 12, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Campus Care Physical Therapy LLC

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  • NPI 1487201224
  Authorized official Same address or phone
• M Wellness LLC

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  • NPI 1619749231
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539302400000",
    "number": "1407352305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4914 LEXINGTON AVE",
            "city": "BELTSVILLE",
            "state": "MD",
            "postal_code": "207051815",
            "telephone_number": "240-907-8898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9470 ANNAPOLIS RD STE 416",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207063000",
            "telephone_number": "240-770-3505",
            "fax_number": "240-770-4303"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "675 3rd Ave Fl 5",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100175731",
            "country_code": "US",
            "telephone_number": "212-204-5167",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAGALUR MANJUNATHA",
        "first_name": "NIVEDITHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-01",
        "last_updated": "2018-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "042057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanisha Jackson
• Veronica P. Jackson
• Jacqueline Jacobs
• Beatrice Dzekem Jaff
• Gabriel B Jaffe, MD
• Jade Jaggers, MPH, PA-C
• Anna Adekunbi O Jagun
• Stephanie Jaime-Luna
• Agnes Jalloh
• Amadu Jalloh

• Physical Therapist in Lanham, MD
• Providers in Lanham, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.