Healthcare Provider Details

I. General information

NPI: 1639487390
Provider Name (Legal Business Name): PETER A MANSKY MD CONSULTANT LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 S DURANGO DR STE 101
LAS VEGAS NV
89147-8164
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: 702-405-7285
  • Fax: 877-324-7915
Mailing address:
  • Phone: 702-405-7285
  • 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
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER A MANSKY
Title or Position: PRESIDENT
Credential: MD
Phone: 702-405-7285