Provider Demographics
NPI:1417169046
Name:MANCIAMELI, SEBASTIANO (RPH)
Entity Type:Individual
Prefix:MR
First Name:SEBASTIANO
Middle Name:
Last Name:MANCIAMELI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3432 JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1002
Mailing Address - Country:US
Mailing Address - Phone:917-626-8989
Mailing Address - Fax:718-231-1606
Practice Address - Street 1:3432 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1002
Practice Address - Country:US
Practice Address - Phone:917-626-8989
Practice Address - Fax:718-231-1606
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02595637Medicaid
NY02595637Medicaid