Mantilla, Fanny
Mantilla, Fanny is an individual health care provider with primary practice located at 4422 3Rd Ave Care Of Er Department, Bronx NY 10457-2545. She recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as her primary health care specialty. Mantilla, Fanny can be contacted via phone (718) 960-6103.Contact Information
Primary practice address
4422 3Rd Ave Care Of Er Department
Bronx NY 10457-2545
Phone: (718) 960-6103
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 212807 | New York |
Profile Details
| NPI number | 1568416980 |
|---|---|
| LBN Legal business name | Mantilla, Fanny |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 20th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568416980 | NPPES |
| New York | MEDICAID | 02321259 |
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