Provider Demographics
NPI:1568491041
Name:MANLEY, PAUL JOSEPH (RPA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JOSEPH
Last Name:MANLEY
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SOUTH AVE
Mailing Address - Street 2:BOX 58
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2733
Mailing Address - Country:US
Mailing Address - Phone:585-341-6776
Mailing Address - Fax:585-341-8305
Practice Address - Street 1:1000 SOUTH AVE
Practice Address - Street 2:BOX 58
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2733
Practice Address - Country:US
Practice Address - Phone:585-341-6776
Practice Address - Fax:585-341-8305
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002881363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
112354AZOtherPREFERRED CARE
P019002881OtherEXCELLUS
P019002881OtherEXCELLUS
PA0016Medicare ID - Type Unspecified
CC1935Medicare ID - Type Unspecified