Provider Demographics
NPI:1235220872
Name:NIELL-MANENT, JOSE P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:P
Last Name:NIELL-MANENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:P
Other - Last Name:NIELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12 RIDGE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-1235
Mailing Address - Country:US
Mailing Address - Phone:203-322-9278
Mailing Address - Fax:
Practice Address - Street 1:12 RIDGE BROOK DR
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06903-1235
Practice Address - Country:US
Practice Address - Phone:203-322-9278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT15422207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology