Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 254293 | NY |
NPI | 1316108319 |
---|---|
Provider Name | Jayme D Mancini |
First Address | Huntington, NY 11743 |
Second Address | Old Westbury, NY 11568-8000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2008 |
Last Update Date | 12/07/2013 |