Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 114313 | NY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 114313 | NY |
NPI | 1073561312 |
---|---|
Provider Name | Dr. Joseph Mancini |
First Address | Rochester, NY 14607-4008 |
Second Address | Rochester, NY 14607-4008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01684591 | (05) | NY |
80114787 | RAILROAD MEDICARE (01) | NY |
B72478 | (02) | NY |