Provider Demographics
NPI:1437473832
Name:MANENKOFF, ROBERT M (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:MANENKOFF
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:21 S ZELLERS ST
Mailing Address - Street 2:PO BOX 38
Mailing Address - City:MC CLURE
Mailing Address - State:PA
Mailing Address - Zip Code:17841-9722
Mailing Address - Country:US
Mailing Address - Phone:570-415-0510
Mailing Address - Fax:570-415-0510
Practice Address - Street 1:21 S ZELLERS ST
Practice Address - Street 2:
Practice Address - City:MC CLURE
Practice Address - State:PA
Practice Address - Zip Code:17841-9722
Practice Address - Country:US
Practice Address - Phone:570-415-0510
Practice Address - Fax:570-415-0511
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA0017772L2084P0800X
PAOA 000333L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry