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General NPI Number Information
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NPI Number | 1780746883
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Entity Type | Individual
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Provider Name | RICHARD MANZI M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/29/2016
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Provider Practice Location Address
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Address Line | 315 E 72ND ST 12A
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City | NEW YORK
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State | NY
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Zip | 10021-4625
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Country | US
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Telephone | 203-359-9997
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 MAIN ST 12A
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City | BRIDGEPORT
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State | CT
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Zip | 06606-4201
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Country | US
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Telephone | 203-359-9997
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 033147
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License Number State | CT
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