1568491041 NPI number — PAUL JOSEPH MANLEY RPA-C

Table of content: PAUL JOSEPH MANLEY RPA-C (NPI 1568491041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568491041 NPI number — PAUL JOSEPH MANLEY RPA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANLEY
Provider First Name:
PAUL
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1568491041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 SOUTH AVE
Provider Second Line Business Mailing Address:
BOX 58
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14620-2733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-341-6776
Provider Business Mailing Address Fax Number:
585-341-8305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 SOUTH AVE
Provider Second Line Business Practice Location Address:
BOX 58
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14620-2733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-341-6776
Provider Business Practice Location Address Fax Number:
585-341-8305
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  002881 , 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)

  • Identifier: 112354AZ . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P019002881 . This is a "EXCELLUS" identifier . This identifiers is of the category "OTHER".




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