Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 045031 | CT |
NPI | 1194899351 |
---|---|
Provider Name | Richard L Manzo |
First Address | Waterbury, CT 06708-3119 |
Second Address | Waterbury, CT 06708-3119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 01/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C00071 | MEDICARE GROUP NUMBER (01) | CT |