Individual
MRS. CONCETTA MARIE MANISERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
79 MIDDLEVILLE RD, NORTHPORT, NY 11768-2200
(631) 261-4400
(631) 544-5313
Mailing address
23 DOGWOOD RD, KINGS PARK, NY 11754-3405
(631) 971-3717
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F303704-1
NY
Other
Enumeration date
03/02/2006
Last updated
07/08/2007
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