Provider Demographics
NPI:1285196808
Name:MANZIONE, THOMAS JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
Last Name:MANZIONE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GLEN HEAD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1456
Mailing Address - Country:US
Mailing Address - Phone:516-671-1745
Mailing Address - Fax:516-344-5603
Practice Address - Street 1:25 GLEN HEAD RD STE 1
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1456
Practice Address - Country:US
Practice Address - Phone:516-671-1745
Practice Address - Fax:516-344-5603
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0612561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty