Provider Demographics
NPI:1972582138
Name:MANNO, HELENE D (DPM)
Entity Type:Individual
Prefix:DR
First Name:HELENE
Middle Name:D
Last Name:MANNO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1721
Mailing Address - Country:US
Mailing Address - Phone:201-943-7977
Mailing Address - Fax:201-945-4650
Practice Address - Street 1:542 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1721
Practice Address - Country:US
Practice Address - Phone:201-943-7977
Practice Address - Fax:201-945-4650
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00113400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6324200001Medicare NSC
NJT44935Medicare UPIN
NJMA431583Medicare ID - Type Unspecified