MEDICARE: NICOLE MANASSERO

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	225100000X	Physical Therapist	053029	NY

General Provider Information

NPI Number	:	1306799838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MANASSERO

Provider Business Mailing Address
First Line	:	20 MIRIAM ST
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11581-1321
Country	:	US
Telephone Number	:	516-754-4426
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 FRANKLIN AVE BLDG SUITE
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-1502
Country	:	US
Telephone Number	:	516-358-8911
Fax Number	:

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

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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Directions to “ NICOLE MANASSERO ” Practice Location

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