Provider Demographics
NPI:1295032753
Name:WILBERT B. MANIEGO, M.D., P.C.
Entity Type:Organization
Organization Name:WILBERT B. MANIEGO, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:MANIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-343-7600
Mailing Address - Street 1:915 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2529
Mailing Address - Country:US
Mailing Address - Phone:718-343-7600
Mailing Address - Fax:718-343-7603
Practice Address - Street 1:915 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2529
Practice Address - Country:US
Practice Address - Phone:718-343-7600
Practice Address - Fax:718-343-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221557207R00000X
NY221557-1207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty