Provider Demographics
NPI:1063517787
Name:MANIACE, RICHARD P (PNP)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:P
Last Name:MANIACE
Suffix:
Gender:M
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1720
Mailing Address - Country:US
Mailing Address - Phone:716-837-0995
Mailing Address - Fax:716-837-1203
Practice Address - Street 1:2924 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1720
Practice Address - Country:US
Practice Address - Phone:716-837-0995
Practice Address - Fax:716-837-1203
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2025-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381303363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02052371Medicaid
NY384749OtherMVP UPSTATE DHP DOCTORS H
NY01725OtherBLUE SHIELD OF ROCHESTER
4334391OtherAETNA US HEALTHCARE
NYNP0022OtherPREFERRED CARE
P010164923OtherEXCELLUS BLUE CHOICE
RC60164923OtherPOMCO
Y028938OtherTRICARE REGION 1