Provider Demographics
NPI:1073561312
Name:MANCINI, JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:MANCINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ALEXANDER ST
Mailing Address - Street 2:SUITE 708
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-4008
Mailing Address - Country:US
Mailing Address - Phone:585-922-6200
Mailing Address - Fax:
Practice Address - Street 1:220 ALEXANDER ST
Practice Address - Street 2:SUITE 708
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-4008
Practice Address - Country:US
Practice Address - Phone:585-922-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114313207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01684591Medicaid
NY80114787OtherRAILROAD MEDICARE
NY01684591Medicaid
NYB72478Medicare UPIN