Individual
PAUL EDWARD MANICONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 MICHIGAN AVE NW, WEST WING, FLOOR 1.5 SUITE 600, WASHINGTON, DC 20010-2978
(202) 884-5000
Mailing address
307 S EVERGREEN AVE, WOODBURY, NJ 08096-2739
(856) 686-4300
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MA77519
NJ
208000000X
Pediatrics Physician
Primary
MD035621
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0044288
—
NJ
Enumeration date
07/06/2006
Last updated
07/16/2007
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