MEDICARE: MARGHERITA A. MANZ CCC-SLP

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	235Z00000X	Speech-Language Pathologist	006394-1	NY

General Provider Information

NPI Number	:	1427284157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGHERITA A. MANZ CCC-SLP

Provider Business Mailing Address
First Line	:	1646 RESEARCH AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-1019
Country	:	US
Telephone Number	:	917-751-1061
Fax Number	:

Provider Business Practice Location Address
First Line	:	1646 RESEARCH AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-1019
Country	:	US
Telephone Number	:	917-751-1061
Fax Number	:

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

Provider Enumeration Date	:	06/09/2009
Last Update Date	:	06/09/2009

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