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NPI Code Detail

MEDICARE: MR. TYLER MCMANUS

MEDICARE: MR. TYLER MCMANUS
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
1174H00000XHealth EducatorNY

General Provider Information

NPI Number : 1417891391
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TYLER MCMANUS
Provider Business Mailing Address
First Line : 113 43RD ST
Second Line :
City : LINDENHURST
State : NY
Zip : 11757-2731
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 35 LONGWOOD RD
Second Line :
City : MIDDLE ISLAND
State : NY
Zip : 11953-2045
Country : US
Telephone Number : 631-924-0008
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2026
Last Update Date : 04/20/2026

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