Provider Demographics
NPI:1700599743
Name:CORPORAN MANZUETA, ZORAYA R
Entity type:Individual
Prefix:
First Name:ZORAYA
Middle Name:R
Last Name:CORPORAN MANZUETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15916 UNION TPKE STE 325
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1977
Mailing Address - Country:US
Mailing Address - Phone:347-974-3436
Mailing Address - Fax:718-267-5442
Practice Address - Street 1:15916 UNION TPKE STE 325
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1977
Practice Address - Country:US
Practice Address - Phone:347-974-3436
Practice Address - Fax:718-267-5442
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131560091041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6004862008155537000Medicaid