Provider Demographics
NPI:1417954462
Name:MANZI, JOSEPH A (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:MANZI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1124
Mailing Address - Country:US
Mailing Address - Phone:518-439-0423
Mailing Address - Fax:518-478-9044
Practice Address - Street 1:261 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1124
Practice Address - Country:US
Practice Address - Phone:518-439-0423
Practice Address - Fax:518-478-9044
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003632-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1129470001OtherDME MEDICARE
NY00852942Medicaid
NY480003192OtherRAILROAD MEDICARE
NY1129470001OtherDME MEDICARE
NY39610BMedicare PIN