Healthcare Provider Details

I. General information

NPI: 1336079649
Provider Name (Legal Business Name): MANOACH N ST HILAIRE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26721 ANABLE AVE
EVANS MILLS NY
13637-3212
US

IV. Provider business mailing address

26721 ANABLE AVE
EVANS MILLS NY
13637-3212
US

V. Phone/Fax

Practice location:
  • Phone: 754-308-2437
  • Fax:
Mailing address:
  • Phone: 754-308-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: