Provider Demographics
NPI:1588879753
Name:HONOR G MANILLA
Entity type:Organization
Organization Name:HONOR G MANILLA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:HONOR
Authorized Official - Middle Name:G
Authorized Official - Last Name:MANILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-584-8009
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:2060 VALLEY FORGE RD
Mailing Address - City:WORCESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19490-0070
Mailing Address - Country:US
Mailing Address - Phone:610-584-8009
Mailing Address - Fax:
Practice Address - Street 1:2060 VALLEY FORGE RD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:PA
Practice Address - Zip Code:19490-0070
Practice Address - Country:US
Practice Address - Phone:610-584-8009
Practice Address - Fax:610-584-8679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003187L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007682310003Medicaid
PA4384430001Medicare NSC
PA038660Medicare PIN
PAT30029Medicare UPIN