Provider Demographics
NPI:1710164223
Name:JOSEPH A MANZI DPM
Entity Type:Organization
Organization Name:JOSEPH A MANZI DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANZI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:518-439-0423
Mailing Address - Street 1:261 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1124
Mailing Address - Country:US
Mailing Address - Phone:518-439-0423
Mailing Address - Fax:518-478-9044
Practice Address - Street 1:261 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1124
Practice Address - Country:US
Practice Address - Phone:518-439-0423
Practice Address - Fax:518-478-9044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003632335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1129470001Medicare NSC