Provider Demographics
NPI:1891197968
Name:MANUCHARIAN, STEPHAN (CP, BOCO, FAAOP)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:
Last Name:MANUCHARIAN
Suffix:
Gender:M
Credentials:CP, BOCO, FAAOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6796
Mailing Address - Country:US
Mailing Address - Phone:718-858-2400
Mailing Address - Fax:718-858-9258
Practice Address - Street 1:141 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6796
Practice Address - Country:US
Practice Address - Phone:718-858-2400
Practice Address - Fax:718-858-9258
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-20
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist