Healthcare Provider Details

I. General information

NPI: 1316360662
Provider Name (Legal Business Name): DR. NYLA MANNING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 82ND ST # 37-22
JACKSON HEIGHTS NY
11372-7032
US

IV. Provider business mailing address

3712 82ND ST # 37-22
JACKSON HEIGHTS NY
11372-7032
US

V. Phone/Fax

Practice location:
  • Phone: 718-879-1600
  • Fax:
Mailing address:
  • Phone: 718-879-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number284967
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number284967
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: