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Individual

MARK JESUITAS MANANSALA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
301 PROSPECT AVE, SYRACUSE, NY 13203
(315) 448-5111
Mailing address
7770 TIRRELL HILL CIR, LIVERPOOL, NY 13090-2508
(315) 427-9414

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
575973
NY
363L00000X
Nurse Practitioner
Primary
343488
NY

Other

Enumeration date
06/21/2018
Last updated
08/21/2018
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