Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 242398 | NY |
Y | 2086S0129X | Vascular Surgeon | 242398-1 | NY |
N | 2086S0129X | Vascular Surgeon | 25MA08210100 | NJ |
NPI | 1144431362 |
---|---|
Provider Name | Dr. George Manis |
First Address | Whippany, NJ 07981-1435 |
Second Address | Far Rockaway, NY 11691-4423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2007 |
Last Update Date | 03/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03232419 | (05) | NY |