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NPI Code Detail

MEDICARE: DR. ALLYSEN MANZ PH.D.

MEDICARE: DR. ALLYSEN MANZ PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist016492NY

General Provider Information

NPI Number : 1346213030
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALLYSEN MANZ PH.D.
Provider Business Mailing Address
First Line : 570 WESTMINSTER RD
Second Line :
City : BROOKLYN
State : NY
Zip : 11230-1448
Country : US
Telephone Number : 917-293-7734
Fax Number : 212-806-0706
Provider Business Practice Location Address
First Line : 130 5TH AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10011-4306
Country : US
Telephone Number : 917-293-7734
Fax Number : 212-806-0706
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2006
Last Update Date : 07/12/2007

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