Provider Demographics
NPI:1487648812
Name:MANCO, BARBARA (ANP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:MANCO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 PIKE STREET
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771
Mailing Address - Country:US
Mailing Address - Phone:845-858-1456
Mailing Address - Fax:845-858-1459
Practice Address - Street 1:RCWATC
Practice Address - Street 2:117 SEWARD AVE, SUITE 12-16
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-341-2543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304044-1363LA2200X
NY320528-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner