Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | N003632-1 | NY |
NPI | 1417954462 |
---|---|
Provider Name | Joseph A Manzi |
First Address | Delmar, NY 12054-1124 |
Second Address | Delmar, NY 12054-1124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2005 |
Last Update Date | 22/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00852942 | (05) | NY |
1129470001 | DME MEDICARE (01) | NY |
480003192 | RAILROAD MEDICARE (01) | NY |
T26616 | (02) | NY |