MEDICARE: DR. ADRIANA MANTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	212397	NY

General Provider Information

NPI Number	:	1194838524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADRIANA MANTA M.D.

Provider Business Mailing Address
First Line	:	920 CASTLE HILL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-1380
Country	:	US
Telephone Number	:	718-824-0500
Fax Number	:	718-824-2373

Provider Business Practice Location Address
First Line	:	920 CASTLE HILL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-1320
Country	:	US
Telephone Number	:	718-824-0500
Fax Number	:	718-824-2373

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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