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Individual

JEFFREY MICHAEL MANZANO AQUINO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(732) 439-8519
Mailing address
124 COLONY PL, MADISON, MS 39110
(732) 439-8519

Taxonomy

Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
25MA10601300
NJ
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
30124
MS
390200000X
Student in an Organized Health Care Education/Training Program
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1245681683
NY
Enumeration date
06/27/2016
Last updated
07/14/2022
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