Provider Demographics
NPI:1609867217
Name:MANNA, GENO (MD)
Entity Type:Individual
Prefix:
First Name:GENO
Middle Name:
Last Name:MANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 POST AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2201
Mailing Address - Country:US
Mailing Address - Phone:516-333-1444
Mailing Address - Fax:516-333-2725
Practice Address - Street 1:372 POST AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-2201
Practice Address - Country:US
Practice Address - Phone:516-333-1444
Practice Address - Fax:516-333-2725
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY133936207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY26A561Medicare ID - Type UnspecifiedEMPIRE MEDICARE
C07395Medicare UPIN