Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 403396 | NY |
NPI | 1013599067 |
---|---|
Provider Name | John Mantas |
First Address | Schenectady, NY 12304-1009 |
Second Address | Schenectady, NY 12307-1511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2021 |
Last Update Date | 21/06/2021 |