Provider Demographics
NPI:1598152464
Name:MANOSALVAS, GLADYS
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:MANOSALVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 RICHBELL RD
Mailing Address - Street 2:APT. C4
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3235
Mailing Address - Country:US
Mailing Address - Phone:718-753-0194
Mailing Address - Fax:
Practice Address - Street 1:302 RICHBELL RD
Practice Address - Street 2:APT. C4
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3235
Practice Address - Country:US
Practice Address - Phone:718-753-0194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-18
Last Update Date:2015-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY777619131390200000X
NY777620131390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program