Provider Demographics
NPI:1972788917
Name:MANIERRE, STEVEN A (RPA-C)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:MANIERRE
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MADISON AVENUE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3219
Mailing Address - Country:US
Mailing Address - Phone:607-734-1581
Mailing Address - Fax:607-767-4109
Practice Address - Street 1:200 MADISON AVENUE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3219
Practice Address - Country:US
Practice Address - Phone:607-734-1581
Practice Address - Fax:607-767-4109
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003444363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS22250Medicare UPIN
NYS22250Medicare PIN