Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 286973 | NY |
NPI | 1063830750 |
---|---|
Provider Name | Camille Manuel |
First Address | Manhasset, NY 11030-3816 |
Second Address | Manhasset, NY 11030-3816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2014 |
Last Update Date | 13/07/2020 |