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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 17 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568416980 NPPES
New York MEDICAID 02321259

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