Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 205861 | NY |
NPI | 1003882283 |
---|---|
Provider Name | Dr. Michele Manka-Black |
First Address | W Amherst, NY 14228-2041 |
Second Address | Amherst, NY 14228-2041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01824304 | (05) | NY |