Provider Demographics
NPI:1447234802
Name:MANLEY, JOHN C (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:MANLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5214
Mailing Address - Country:US
Mailing Address - Phone:914-637-3510
Mailing Address - Fax:914-819-0061
Practice Address - Street 1:1312 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3121
Practice Address - Country:US
Practice Address - Phone:203-756-6422
Practice Address - Fax:203-756-2448
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029933207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02727388Medicaid
NY9K0021Medicare PIN
NY02727388Medicaid
NY9K002ZXWW1Medicare PIN
NY06509NMedicare PIN
CT050001520Medicare PIN
NY9K002ZT5H1Medicare PIN
CTE07202Medicare UPIN