Healthcare Provider Details

I. General information

NPI: 1972788917
Provider Name (Legal Business Name): STEVEN A. MANIERRE RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MADISON AVENUE
ELMIRA NY
14901-3219
US

IV. Provider business mailing address

200 MADISON AVENUE 3RD FLOOR
ELMIRA NY
14901-3219
US

V. Phone/Fax

Practice location:
  • Phone: 607-734-1581
  • Fax: 607-767-4109
Mailing address:
  • Phone: 607-734-1581
  • Fax: 607-767-4109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number003444
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: