Provider Demographics
NPI:1356392427
Name:MANIEGO, WILBERT B (MD)
Entity type:Individual
Prefix:DR
First Name:WILBERT
Middle Name:B
Last Name:MANIEGO
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 1:915 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2529
Mailing Address - Country:US
Mailing Address - Phone:718-343-7600
Mailing Address - Fax:718-343-7603
Practice Address - Street 1:915 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2529
Practice Address - Country:US
Practice Address - Phone:718-343-7600
Practice Address - Fax:718-343-7603
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02349580Medicaid
NY6504EJMedicare ID - Type Unspecified
NY02349580Medicaid