Provider Demographics
NPI:1104267988
Name:MANIS, MAUREEN VERONICA (SPECIAL ED TEACHER)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:VERONICA
Last Name:MANIS
Suffix:
Gender:F
Credentials:SPECIAL ED TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 4TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1831
Mailing Address - Country:US
Mailing Address - Phone:516-448-3765
Mailing Address - Fax:
Practice Address - Street 1:2130 4TH ST
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1831
Practice Address - Country:US
Practice Address - Phone:516-448-3765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist