Provider Demographics
NPI:1538149356
Name:MANOS, ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:MANOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 5TH AVE
Mailing Address - Street 2:SUITE2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2653
Mailing Address - Country:US
Mailing Address - Phone:212-879-5051
Mailing Address - Fax:212-734-0431
Practice Address - Street 1:936 5TH AVE
Practice Address - Street 2:SUITE2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2653
Practice Address - Country:US
Practice Address - Phone:212-879-5051
Practice Address - Fax:212-734-0431
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS164785207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A63673Medicare UPIN