Provider Demographics
NPI:1699987933
Name:MANZOLILLO, JANICE RITA
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:RITA
Last Name:MANZOLILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HOWELL ST
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3315
Mailing Address - Country:US
Mailing Address - Phone:516-781-2794
Mailing Address - Fax:
Practice Address - Street 1:103 HOWELL ST
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3315
Practice Address - Country:US
Practice Address - Phone:516-781-2794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001853-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist