Healthcare Provider Details

I. General information

NPI: 1740106285
Provider Name (Legal Business Name): JAMIE THERESE MANALASTAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

33 CORNELL DR
EAST BRUNSWICK NJ
08816-5316
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5437
  • Fax:
Mailing address:
  • Phone: 732-887-6290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number350626
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: