1619933702 NPI number — BETTY REYNOLDS MANNING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619933702 NPI number — BETTY REYNOLDS MANNING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETTY REYNOLDS MANNING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619933702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
949 EAST 105TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-257-0914
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
451 CHARLESON AVE
Provider Second Line Business Practice Location Address:
KINGS COUNTY HOSP
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-257-0914
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REYNOLD MANNING
Authorized Official First Name:
BETTY
Authorized Official Middle Name:
HATHEE
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
718-257-0914

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  360288 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)