Basic Information
| Provider Information | |||||||||
| NPI: | 1972788917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANIERRE | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | RPA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MADISON AVENUE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | ELMIRA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 149013219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077341581 | ||||||||
| FaxNumber: | 6077674109 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 MADISON AVENUE | ||||||||
| Address2: | |||||||||
| City: | ELMIRA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 149013219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077341581 | ||||||||
| FaxNumber: | 6077674109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2008 | ||||||||
| LastUpdateDate: | 02/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 003444 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.