Provider Demographics
NPI:1205970613
Name:MANARO, ROBERT AGATINO (MD,)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:AGATINO
Last Name:MANARO
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:PO BOX 141288
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1288
Mailing Address - Country:US
Mailing Address - Phone:718-967-6600
Mailing Address - Fax:
Practice Address - Street 1:3992 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2408
Practice Address - Country:US
Practice Address - Phone:718-967-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142769207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00570925Medicaid
NYRM048C9810OtherBCBS
NYA400001591OtherMEDICARE PTAN
NY444012474OtherRAILROAD MEDICARE
NY00570925Medicaid
35A011Medicare ID - Type Unspecified
NYB13552Medicare UPIN