Healthcare Provider Details

I. General information

NPI: 1316108319
Provider Name (Legal Business Name): JAYME D MANCINI D.O., PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHERN BLVD NYIT ACADEMIC HEALTH CARE CENTER
OLD WESTBURY NY
11568-8000
US

IV. Provider business mailing address

64 N WOODHULL RD, UNIT 3
HUNTINGTON NY
11743
US

V. Phone/Fax

Practice location:
  • Phone: 516-686-3700
  • Fax:
Mailing address:
  • Phone: 631-697-5975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number254293
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: