Provider Demographics
NPI:1528276490
Name:MANZON, GABRIEL JOHN (MPT)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:JOHN
Last Name:MANZON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 W 55TH ST APT 4D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3747
Mailing Address - Country:US
Mailing Address - Phone:646-373-4832
Mailing Address - Fax:
Practice Address - Street 1:131 W 35TH ST FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2111
Practice Address - Country:US
Practice Address - Phone:212-967-5337
Practice Address - Fax:212-967-5157
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02616212251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic