Provider Demographics
NPI:1942489463
Name:MANN, CORAL DAFINONE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:CORAL
Middle Name:DAFINONE
Last Name:MANN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 S STONE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-3607
Mailing Address - Country:US
Mailing Address - Phone:646-334-7005
Mailing Address - Fax:
Practice Address - Street 1:70 S STONE AVE
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-3607
Practice Address - Country:US
Practice Address - Phone:646-334-7005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288252164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02872993Medicaid