Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 263140 | NY |
Y | 2080P0204X | Pediatric Emergency Doctor | 263140 | NY |
NPI | 1295047850 |
---|---|
Provider Name | Dr. Gonzalo Andres Manzano |
First Address | Pelham, NY 10803-1803 |
Second Address | Bronx, NY 10467-2403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2010 |
Last Update Date | 01/03/2020 |