Provider Demographics
NPI:1902275696
Name:MANNELLINO, MARGARET ERIN (NP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ERIN
Last Name:MANNELLINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX 629
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-1152
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 GREECE CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-1152
Practice Address - Country:US
Practice Address - Phone:585-723-9100
Practice Address - Fax:585-758-1299
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 673870163W00000X
NYF344411-1207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No163W00000XNursing Service ProvidersRegistered Nurse