Provider Demographics
NPI:1720155922
Name:MANZI, GAETANO (MD)
Entity Type:Individual
Prefix:DR
First Name:GAETANO
Middle Name:
Last Name:MANZI
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 1:332 DEKALB AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3820
Mailing Address - Country:US
Mailing Address - Phone:718-852-5252
Mailing Address - Fax:718-802-1113
Practice Address - Street 1:332 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3820
Practice Address - Country:US
Practice Address - Phone:718-852-5252
Practice Address - Fax:718-802-1113
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144329207RG0100X
NJMA05628800207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400037455OtherMEDICARE ID -TYPE UNSPECIFIED
NY00820200Medicaid
WET021Medicare PIN