Provider Demographics
NPI:1063485043
Name:MANZO, VILDAN (MD)
Entity Type:Individual
Prefix:
First Name:VILDAN
Middle Name:
Last Name:MANZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 5TH AVE 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0724
Mailing Address - Country:US
Mailing Address - Phone:212-369-2490
Mailing Address - Fax:212-831-3031
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:WESTCHESTER PATHOLOGY ASSOCIATES
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3417
Practice Address - Country:US
Practice Address - Phone:845-562-7995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179258-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1J5401OtherBLUE CROSS PROVIDER #
NY20L711Medicare ID - Type Unspecified
NYF46120Medicare UPIN