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General NPI Number Information
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NPI Number | 1245681683
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Entity Type | Individual
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Provider Name | JEFFREY MICHAEL MANZANO AQUINO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 2500 N STATE ST
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 732-439-8519
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Fax |
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Provider Business Mailing Address
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Address Line | 124 COLONY PL
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City | MADISON
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State | MS
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Zip | 39110
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Country | US
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Telephone | 732-439-8519
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 25MA10601300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 30124
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License Number State | MS
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