Provider Demographics
NPI:1700802162
Name:MANOCCHIO, GENNARO (ATC)
Entity Type:Individual
Prefix:MR
First Name:GENNARO
Middle Name:
Last Name:MANOCCHIO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 CHURCH CROSS RD
Mailing Address - Street 2:
Mailing Address - City:FREWSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14738-9738
Mailing Address - Country:US
Mailing Address - Phone:716-569-2296
Mailing Address - Fax:
Practice Address - Street 1:350 E 2ND ST
Practice Address - Street 2:JAMESTOWN HIGH SCHOOL
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5623
Practice Address - Country:US
Practice Address - Phone:716-483-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0002612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer