Healthcare Provider Details

I. General information

NPI: 1609185172
Provider Name (Legal Business Name): MANSKY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9811 W CHARLESTON BLVD STE 2-735
LAS VEGAS NV
89117-7528
US

IV. Provider business mailing address

9811 W CHARLESTON BLVD STE 2-735
LAS VEGAS NV
89117-7528
US

V. Phone/Fax

Practice location:
  • Phone: 702-257-6727
  • Fax: 877-324-7915
Mailing address:
  • Phone: 702-257-6727
  • Fax: 877-324-7915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER A MANSKY
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 702-257-6727