1801978010 NPI number — MANOS FAMILY PRACTICE PC

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 1801978010 NPI number — MANOS FAMILY PRACTICE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANOS FAMILY PRACTICE PC
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:
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:
1801978010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 OLD FERN HILL RD
Provider Second Line Business Mailing Address:
BUILDING D SUITE 500
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19380-4269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-235-4100
Provider Business Mailing Address Fax Number:
610-235-4107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 OLD FERN HILL RD
Provider Second Line Business Practice Location Address:
BUILDING D SUITE 500
Provider Business Practice Location Address City Name:
WEST CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19380-4269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-235-4100
Provider Business Practice Location Address Fax Number:
610-235-4107
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MANOS
Authorized Official First Name:
ANTONINUS
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-235-4100

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS006148L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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