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General NPI Number Information
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NPI Number | 1417572173
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Entity Type | Individual
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Provider Name | FAIRY LAINE ESPINA MANZANO
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Gender | Female
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Dates
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Enumeration Date | 06/09/2020
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Last Update Date | 04/13/2025
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Provider Practice Location Address
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Address Line | 20 EXETER AVE
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City | LYNBROOK
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State | NY
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Zip | 11563-3710
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Country | US
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Telephone | 347-351-2454
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Fax |
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Provider Business Mailing Address
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Address Line | 600 E 125TH ST
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City | NEW YORK
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State | NY
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Zip | 10035-6000
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Country | US
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Telephone | 646-766-4000
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 406726
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 730040
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License Number State | NY
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