Provider Demographics
NPI:1598761660
Name:MANNINO, MICHAEL M (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:MANNINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1155 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3040
Mailing Address - Country:US
Mailing Address - Phone:516-407-4000
Mailing Address - Fax:516-869-0763
Practice Address - Street 1:1615 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3033
Practice Address - Country:US
Practice Address - Phone:516-627-9355
Practice Address - Fax:516-869-0763
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY182581207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF27688Medicare UPIN
NY62K311Medicare ID - Type Unspecified