Provider Demographics
NPI:1811244163
Name:MARANAN, EMMANUEL ALCANCIA
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:ALCANCIA
Last Name:MARANAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4458
Mailing Address - Country:US
Mailing Address - Phone:718-372-6888
Mailing Address - Fax:718-372-9999
Practice Address - Street 1:8610 25TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4458
Practice Address - Country:US
Practice Address - Phone:718-372-6888
Practice Address - Fax:718-372-9999
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400093370Medicare UPIN