Provider Demographics
NPI:1063078954
Name:MCMANUS, GINA
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 FLOWER HILL RD
Mailing Address - Street 2:
Mailing Address - City:HALESITE
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2311
Mailing Address - Country:US
Mailing Address - Phone:631-335-7720
Mailing Address - Fax:
Practice Address - Street 1:7 HIGH ST STE 201
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3417
Practice Address - Country:US
Practice Address - Phone:631-423-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308682901246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other