Provider Demographics
NPI:1578919858
Name:MANNING, JAMIE ROSEN
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ROSEN
Last Name:MANNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:ROSEN
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:875 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4952
Mailing Address - Country:US
Mailing Address - Phone:212-288-3200
Mailing Address - Fax:
Practice Address - Street 1:1056 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0112
Practice Address - Country:US
Practice Address - Phone:917-757-8747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304669207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology