MEDICARE: DR. STEVE MANZON D.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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	050702-1	NY

General Provider Information

NPI Number	:	1811093404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVE MANZON D.M.D.

Provider Business Mailing Address
First Line	:	2908 EMMONS AVE
Second Line	:	UNIT 2920
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2243
Country	:	US
Telephone Number	:	347-741-7023
Fax Number	:

Provider Business Practice Location Address
First Line	:	1777 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-2060
Country	:	US
Telephone Number	:	718-998-9114
Fax Number	:

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	03/23/2010

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