Healthcare Provider Details

I. General information

NPI: 1063485043
Provider Name (Legal Business Name): VILDAN MANZO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E MAIN ST WESTCHESTER PATHOLOGY ASSOCIATES
MOUNT KISCO NY
10549-3417
US

IV. Provider business mailing address

1150 5TH AVE 1B
NEW YORK NY
10128-0724
US

V. Phone/Fax

Practice location:
  • Phone: 845-562-7995
  • Fax:
Mailing address:
  • Phone: 212-369-2490
  • Fax: 212-831-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number179258-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: