Provider Demographics
NPI:1427249986
Name:MANLEY, MYRL RAY STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:MYRL
Middle Name:RAY STEPHEN
Last Name:MANLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:95 PIERREPONT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2704
Mailing Address - Country:US
Mailing Address - Phone:718-875-8937
Mailing Address - Fax:718-625-1744
Practice Address - Street 1:95 PIERREPONT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2704
Practice Address - Country:US
Practice Address - Phone:718-875-8937
Practice Address - Fax:718-625-1744
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1461302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY77A701Medicare PIN